AbstractPsychological and social problems have been documented as sequelae of mastectomy. Patients may experience depression, anxiety, decreased sexual interest, negative changes in body image, fears of recurrence and concerns regarding the mastectomy site or prosthesis. Immediate breast reconstruction, using improved techniques such as the TRAM flap, have lessened the negative psychological impact of mastectomy but whether these procedures themselves result in psychologic or sexual impairment has not been reported. We, therefore, report four patients, three of whom were self‐referred for psychiatric evaluation, who experienced changes in body image and sexual response after TRAM flap reconstruction. Although the TRAM flap procedure cannot be specifically implicated, the similar presentation and complaints in these four cases suggest a possible association that warrants more rigorous stud