Purpose/Introduction: To identify patient-reported barriers to breast reconstruction (BR) in eligible women using a prospective qualitative approach. Uptake to breast reconstruction remains low in regional populations despite known benefits. Limited data exist on the underlying patient-reported barriers to breast reconstruction in regional populations. Methods: A prospective qualitative study was conducted within a regional Australian health district. Women who were eligible for BR but did not undergo reconstruction between 2017–2022 were invited to participate (n = 227). A novel questionnaire was administered, incorporating Likert-scale items across six domains (information provision, access to services, logistical barriers, psychosocial factors, clinician communication, and expectations), with open-ended excerpts. Group differences were explored using chi-square analysis, and thematic analysis. Results: Many participants reported inadequate counselling regarding reconstructive options, limited access to subspecialist services, and significant logistical barriers including travel distance, cost, and waiting times. Over 70% of respondents stated reconstruction was not presented as a realistic or accessible option, and 64% felt insufficiently informed to make a confident decision. Prominent themes included fragmented referral pathways, poor continuity of care, and perceptions of reconstruction as cosmetic only. Several patients described changes in treating surgeons, lack of coordinated follow-up, and believed further corrective surgery would require private payment. Conclusion: Regional women face systemic and informational barriers to breast reconstruction extending beyond clinical eligibility. Patient-reported experiences highlight gaps in counselling, referral pathways, and service continuity. These findings support the need for structured multidisciplinary counselling, improved regional reconstructive access, and clearer framing of reconstruction as a component of oncologic care.