Background. Mastectomy can lead to profound psychological effects, including a disturbed body image, particularly among geriatric women. Body image concerns post-surgery often contribute to emotional distress, social withdrawal, and decreased quality of life. This study aimed to evaluate the effectiveness of basic counseling in enhancing body image among geriatric women after mastectomy. Objectives. To assess changes in body image scores before and after a structured counseling intervention, and to evaluate the association between demographic variables and body image perception among geriatric women post-mastectomy. Methods. A quasi-experimental study with a pretest-posttest control group design was conducted among 140 geriatric women (≥65 years) who had undergone mastectomy in selected hospitals of Madurai and Tirunelveli districts. Participants were equally divided into experimental (n=70) and control (n=70) groups using purposive sampling. The experimental group received structured basic counseling in four sessions over 60 days, while the control group received routine postoperative care. Body image was assessed using a 22-item Likert-scale tool at four time points: pretest (day 3 post-surgery), posttest-I (day 10), posttest-II (day 30), and posttest-III (day 60). Data were analyzed using repeated measures ANOVA, chi-square tests, and descriptive statistics. Results. The experimental group showed a significant improvement in mean body image scores from 50.89 (pretest) to 77.23 (posttestIII), compared to minimal change in the control group (51.17 to 52.46). Repeated measures ANOVA revealed statistically significant differences (F = 21.97, p < 0.001). No significant associations were found between body image scores and demographic variables. The body image gain score was 25.86% in the experimental group versus 2.57% in the control group. Conclusion. Basic counseling significantly enhanced positive body image among geriatric women after mastectomy. Incorporating structured psychosocial interventions into post-mastectomy care is recommended. © Società Editrice Universo (SEU).