Background: Breast cancer incidence in women aged ≥70 years is steadily increasing, and many are choosing to undergo postmastectomy breast reconstruction (PMBR). We aimed to identify factors associated with PMBR, describe reconstruction types, and assess postoperative mortality and re-admission rates in women ≥70 years of age. Methods: The National Cancer Database (NCDB) was examined between 2004 and 2015 for women aged ≥70 years with breast cancer who underwent mastectomy. Statistical analysis was performed by χ2 tests and multivariate logistic regression to select the best models for predicting PMBR and if patients underwent contralateral prophylactic mastectomy (CPM) with reconstruction. Results: A total 73,973 patients met inclusion criteria and 4,552 (6.1%) underwent PMBR, of which 25% had a CPM. 48% had implant reconstruction, 36.2% underwent autologous reconstruction, and 15.1% received combination reconstruction. PMBR was more likely to be performed in patients who were White, had fewer comorbidities, were treated in the Northeast metropolitan areas, and with lower tumor stage (P < .001). CPM was more likely to be performed in patients who were White and treated in community hospitals in rural areas in the South and West. (P < .05). Although 30-day readmission rates were higher in PMBR patients (3.5% vs 2.8%, P < .001), 30 and 90-day mortality rates were lower: 0.03 and 0.2% vs 0.3 and 0.9% (P < .001). Conclusion: Although it is understandable that intrinsic tumor characteristics influence the role of PMBR, further research and interventions should be aimed to eliminate the differences that are seen in patient race and geographic location. Readmission and postop mortality rates are overall low and comparable to that of younger patients.