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The present study reviewed data from 321,206 breast cancer patients treated with mastectomy from 2000 to 2014 to better understand how clinicopathologic factors can affect the prevalence of immediate breast reconstruction. The results demonstrated the probability of undergoing breast reconstruction significantly declined as patient age at diagnosis increased. Additionally, significant variations in the incidence of immediate breast reconstruction over age were seen across tumor grade and radiation therapy status.Despite the psychological benefits and oncologic safety of postmastectomy breast reconstruction, most breast cancer patients do not undergo reconstruction. To better understand the patterns of breast reconstruction usage, it is important to identify the clinicopathologic factors associated with immediate breast reconstruction (IBR), and whether modification of the reconstruction incidence when stratified by patient- or cancer-related factors exists in the breast cancer population. The primary objectives were to determine whether the incidence of immediate postmastectomy breast reconstruction varies across age, and whether the tumor grade or radiation therapy modify the effect of age on the incidence of immediate breast reconstruction.Using the Surveillance, Epidemiology, and End Results database, we identified women who had undergone mastectomy for breast cancer from 2000 to 2014. Inverse probability of treatment-weighted log-binomial regression was used to estimate the effect of age on IBR after accounting for potential confounding by patient demographic data and cancer characteristics. Potential effect measure modification by tumor grade and radiation therapy on the age–IBR relationship was also assessed.Of 321,206 women, 77,798 (24.2%) had undergone IBR. Age was significantly associated with IBR prevalence (P < .0001), with younger women more likely to undergo IBR. Both tumor grade (P < .0001) and radiation therapy (P < .0001) modified the effect of age on IBR.Compared with their older counterparts, younger breast cancer patients were more likely to undergo IBR, and both tumor grade and radiation therapy were differentially associated with the likelihood of IBR across patient age.