A significant proportion of women diagnosed with breast cancer are over the age of 70 years and there is evidence that these patients frequently do not receive standard treatments, including surgical procedures and adjuvant therapies, which would be routine practice in younger age groups. The factors underlying this may include the physiological effects of ageing, differences in the biology and stage of the tumour at presentation, patient co-morbidities and patient and clinician preferences. The interaction of all these factors needs to be considered when individualising treatment plans for patients. For some patients this will need to be undertaken in the context of an extended multidisciplinary team setting with additional input from geriatricians, in addition to surgeons and oncologists, in defining a treatment plan. Little is known about the preferences of older patients in their choice of surgical treatment for breast cancer and further research is required to increase the evidence base for the rational management of older women with breast cancer.