Background: The NCCN recommends risk-reducing salpingo-oophorectomy (RRSO) for women with BRCA mutations by age 35-40 or upon completion of childbearing. We previously reported that RRSO was being performed at age 43-44; and age 46-47 when fertility considerations were excluded. Since these ages are past the NCCN guidelines, our objective was to elucidate the timing between genetic testing (GT) and risk-reducing surgery (RRS) and reasons for delay. Methods: We conducted a retrospective chart review to identify women with BRCA mutations who underwent RRSO between 2012-2017. We analyzed demographics, date of GT and RRS and reasons for delay in RRS. Results: We identified 187 patients with mutations who underwent RRS: 93 with BRCA1 and 94 with BRCA2. Median age at RRS was 44 (28-77); 43 (31-77) and 45 (28-71), for BRCA1 and BRCA2, respectively. The median time between GT and RRS was 9 (1-171) months (m). Fifty-six percent of patients (n = 105) had a documented reason for delay in RRS: 39 (37%) for future fertility; 25 (24%) for breast cancer (BC) treatment; 14 (13%) due to fear of surgical menopause; 10 (10%) to coordinate with simultaneous breast surgery; 17 (16%) miscellaneous. The median time of delay from mutation diagnosis to RRS among groups was: fertility, 29 (3-171) m; BC, 9 (2-36) m; menopause, 12 (4-76) m; and surgical coordination, 8 (4-13) m. Median age at RRS among groups was: fertility, 39 (31-46) years (y); BC, 45 (28-70) y; menopause, 42 (32-44) y; and surgical coordination, 52 (37-71) y. In patients undergoing RRS after diagnosis of BC, 30 of 36 (83%) had a family history that qualified them for earlier genetic testing by NCCN guidelines. Two of these BC patients had ovarian cancer at the time of RRS. Conclusions: Overall, patients underwent RRS within a year of mutation diagnosis. Patients comprised two distinct groups: those with fertility or menopause concerns who underwent RRS at 39-42 y, close to the NCCN recommended age; and those with BC who underwent RRS at 45-52 y. Over 80% of patients in the BC group qualified for earlier genetic screening. Obtaining a family history, referral for GT, and earlier diagnosis of mutations, prior to development of BC, will be an important step to better comply with NCCN guidelines and prevent ovarian cancer.