Angarita FA, et al. - Using the database of The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), researchers determined the immediate (30-day) postoperative complication rates of older women who had immediate (IBR) and delayed breast reconstruction (DBR) with alloplastic techniques. Women ≥ 70 years old with in situ or invasive breast cancer who had either IBR or DBR (2005–2016) were identified. In total, 2,085 older women had alloplastic breast reconstruction of which 90% and 10% were IBR and DBR, respectively. There were higher rates of infectious complications in the IBR cohort while overall 30-day postoperative complication rates in older women who undergo breast reconstruction were low. There were equal rates of cardiac/transfusion, pulmonary, thromboembolic, renal, and neurological morbidity among groups. The risks and benefits of reconstruction of alloplastic breast should be addressed with older women who undergo mastectomy for treatment of breast cancer.