OBJECTIVES: Women who undergo mastectomy, whether due to a first-time breast cancer diagnosis or recurrence, are often presented with the option of breast reconstruction. Decisions whether to undergo reconstruction are informed by women’s surgery expectations, which develop based on many factors, including past knowledge and experience. The aim of this study was to examine the impact of previous breast cancer diagnosis on a women’s approach to expectation-identification of their reconstructed breast appearance. METHODS: This study was performed using cross-sectional data as part of a larger field-test. Expectations scales of the BREAST-Q PRO were administered in a clinical setting to breast cancer patients seeking immediate breast reconstruction. Responses were categorized into specific (unlikely, somewhat likely, very likely) or vague expectations (don’t know) as the dependent variable. The independent variable was defined as previous or primary diagnosis. Chi Square and one-way ANOVA were performed using SPSS22. RESULTS: The study sample (n = 62; response rate, 66%) was characterized by a mean age of 49.6 ± 9.2 years , 82.3% married, 77.4% employed and 79.0% Caucasian. Twenty-three (37.1%) had a history of previous breast cancer diagnosis without mastectomy. Women who had previous breast cancer diagnosis were more likely to select a specific expectation in response to what their new breast(s) would look like in the mirror clothed (ETA squared; 0.11, P=0.011) and unclothed (ETA squared; 0.09, P=0.017) one year after reconstruction. CONCLUSIONS: Expectancies guide perception, so that people tend to focus on events that are congruent with their expectations. In our study, women undergoing breast reconstruction were more likely to identify a specific expectation about the appearance of their reconstructed breast if they had been previously diagnosed with breast cancer. More research is needed to determine additional factors that may mediate the development of preoperative surgical expectations. Such information will aid in facilitating patient-physician communication.