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This study was performed to describe women’s satisfaction with body image before and 8 weeks after the surgical treatment of breast cancer compared with women without breast cancer. Additional aims were to describe women’s perceived participation in decisions regarding choice of surgical procedure to treat their breast cancer, and postoperative satisfaction with their breast cancer treatment, as well as to explore factors influencing women’s decisions regarding choice of surgical procedure. The design was prospective with a descriptive, comparative design. The convenience sample included 31 women with breast cancer from an urban breast health center, and 30 women without breast cancer from the community. The majority were college educated, white, ranging in age from 29–82 years. Women with breast cancer completed instruments before and 8 weeks after surgery. Women without breast cancer completed the instruments two times 8 weeks apart. Three instruments measuring body image satisfaction were used. Participation in treatment decision-making, having a treatment choice, and posttreatment satisfaction, along with a description of important factors in decision making, were measured with open and closed-ended questions. During the study period, women with breast cancer experienced a significant decrease in satisfaction with body image after surgery (p < .004). Satisfaction with body image remained constant in the women without breast cancer. Most (94%) of the women with breast cancer reported participating in treatment decisions about the type of surgical procedure used to treat their breast cancer, had a treatment choice (77%), and were moderately to very satisfied with the outcome of their surgeries (94%). Qualitative data results suggest that women’s treatment decisions were based on their perceptions of “survival,” that is, which type of surgery offered the best chance for long-term survival. These data suggest that satisfaction with body image is disturbed by surgery for breast cancer despite active participation in decisions regarding selection of treatment or postoperative satisfaction with type of surgical treatment received. These outcomes suggest that women need assistance in adjusting to alterations in body image from nurses and the need for research to describe effective interventions. Future studies of body image and breast cancer treatment should be conducted with larger samples, and at different points after surgery to determine the effects of mastectomy and breast-conserving surgery on the body image of breast cancer survivors over time.