© Lippincott Williams & Wilkins.Introduction Suspension systems are essential components for a lower-limb prosthesis, as they provide sufficient prosthetic fit. Although various adverse and positive effects have been reported for suspension systems, it is important to determine the effects on the prosthesis users in detail. Objective The aim of this study was to compare the pin suspension system (PSS) with the vacuum-assisted suspension system (VASS) in terms of parameters including walking capacity, functional mobility, weight bearing on the operated side, prosthesis satisfaction, and body image perception. Study Design This is an original research report. Methods Nine individuals with transtibial amputation were evaluated. Both suspension systems were applied consecutively. Initially, participants used the PSS for 3 months after fabrication and adjustment of the prosthesis and a prosthetic training period. They then used the VASS for 3 months after a similar training period. After both prosthetic systems had been adjusted, L.A.S.A.R. Posture was used to determine weight bearing on the prosthetic side. The 6-minute walk test was applied for walking capacity, the timed up-and-go test was used to determine functional mobility, the Prosthetic Satisfaction Index was used for prosthetic satisfaction, and the Amputee Body Image Scale was used for body image perception. Results Significant differences were observed between PSS and VASS in terms of prosthetic side weight-bearing ratios, walking capacity, functional mobility, and prosthetic satisfaction (P < 0.05), all in favor of VASS. No significant difference was determined in terms of body image scores (P > 0.05). Conclusion In terms of function and prosthetic satisfaction in individuals with transtibial amputation, VASS was determined to be superior. The available evidence suggests that if there is no contraindication for the use of VASS, it may contribute to the individual with amputation functionally and increase the satisfaction with the prosthesis. Clinical Relevance Vacuum systems can make a positive contribution to reaching the goals for prosthesis users who are targeted to have high physical activity levels. This positive contribution includes increased weight transfer to the prosthetic side, an increase in mobility determinants, and increased prosthesis satisfaction, which has many dimensions.