--- - |2+ Abstract Objective Older age is associated with lower rates of breast reconstruction (BR) for women requiring mastectomy. This study compared patient‐reported outcomes between women aged 60 years and older who had received mastectomy and BR with those who received no BR (NBR). Methods About 135 women aged 60 or over treated between 2009 and 2016 with mastectomy only (N = 87) or mastectomy with BR (N = 48) for primary breast cancer completed patient‐reported outcome measures using a set of validated questionnaires. Reasons for choosing or declining BR were also explored using a set of nonvalidated questionnaires. Results Patients who received BR were generally younger (P = <0.001) and reported greater satisfaction with their bodies (P = 0.048) than NBR patients. Patients with autologous reconstruction reported greater satisfaction with their breasts than implant‐based reconstruction patients. Both BR and NBR patients reported good quality of life, low pain scores, good body image, and low levels of decisional regret. Conclusions These data do not identify any quality of life‐related reasons to not offer clinically fit, well‐informed older women the option of BR. - Psycho-Oncology, EarlyView.