The recent announcement by the high profile actress, Angelina Jolie, that she had had a preventive double mastectomy because she had a high genetic risk of breast and ovarian cancer will lead other women who are at risk to consider similar operations. Psychiatrists and other physicians are likely to be asked to advise women concerning this decision. This column discusses the psychological impact of mastectomy and breast reconstruction for women and encourages clinicians to have an empathic and understanding attitude and allow patients to talk openly about their fears, doubts, concerns about sexual intimacy, and other issues. It is also important to let women experiencing psychological reactions to mastectomy know that such feelings are normal and usually recede in time.