• The well-documented psychological disturbances that follow mastectomy have been said to be less frequent and intense in postclimacteric women. Data from our interviews with mastectomy patients, 12 of whom were postclimacteric, indicate otherwise. Their distress was often outwardly different, but inwardly still traumatic. During frequent, open-ended interviews, feelings were revealed of loss, depression, and shame about sexual feelings that the patients believed to be inappropriate to their age. These revelations were facilitated by the frequency of the interviews, the decreasing unconscious use of denial as time passed, and the knowledge of the possibility of breast reconstruction. The patients' need to pretend to themselves and others that the mastectomy was relatively unimportant added an extra burden to the usual stress of coping with midlife anxieties. Reconstruction decreased the mastectomized woman's feelings of dependence and mutilation.