Introduction. Recent studies have reported increases in the rate of mastectomy and contralateral prophylactic mastectomy (CPM). We hypothesized that there would be different reasons for choosing mastectomy for women aged <50 compared with those aged ≥50 years. Methods. A questionnaire was administered to 332 patients who underwent unilateral or bilateral mastectomy for breast cancer from 2006 to 2010. The survey queried on demographics, surgical choices, and rationale for those choices. A retrospective chart review was performed to determine tumor characteristics. Responses and clinical characteristics were described by contingency tables and compared using Fisher exact test or X 2 test, as appropriate. Results. Of 332 patients surveyed, 310 were evaluable. Median age was 55 years, including 88 patients <50 (28 %) and 222 patients ≥50 (72 %) at time of diagnosis. Forty-four percent of women<50 and 41 % of women ≥50 were given the option of breast conservation and chose mastectomy (p>0.63). The two groups did not differ in their reason for choosing mastectomy, with lower recurrence risk and improved survival cited as the two most common reasons. Younger patients were more likely to undergo reconstruction and CPM (p<0.0001) as well as have estrogen receptor-negative tumors, undergo neoadjuvant chemotherapy, and have higher magnetic resonance imaging utilization (p<0.05). Conclusions. Choosing mastectomy and the reasons for doing so were the same for women aged<50 and ≥50 years. Prospective studies are needed to determine whether patient education regarding perceived versus actual recurrence risk and survival would alter this decision-making process.