Prophylactic bilateral mastectomy, or preventive removal of the breasts, is an option for women who are at increased risk of developing breast cancer. Among the highest risk groups are those women with a significant family history of breast cancer and those with a known genetic predisposition to the disease. There are many issues surrounding prophylactic mastectomy. Recent research has demonstrated that prophylactic mastectomy may be effective in preventing breast cancer in high-risk women, as well as those with a known BRCA1/2 mutation. The limited research that has been done on the psychosocial implications of the preventive surgery suggests that prophylactic mastectomy may be effective in reducing distress levels in high-risk women and that most women who have had the surgery do not experience psychosocial difficulties. Overall, women who have had prophylactic mastectomy are satisfied with their decision to have the preventive surgery. However, women who choose prophylactic mastectomy may differ compared with those who do not. The results may not be generalizable to all high-risk women. Counseling of high-risk women, specifically those with a BRCA1 or BRCA2 mutation, should include a discussion of prophylactic mastectomy, including the medical and psychosocial risks and benefits.