With availability of genetic testing and development of statistical models for risk stratification, more women are being identified as having increased risk for breast cancer. A number of risk-reducing treatment options with varying efficacy exist for them, including frequent surveillance, chemoprevention, prophylactic salpingo-oophorectomy (PSO), and prophylactic mastectomy (PM). Those most likely to benefit from PM are BRCA gene carriers and those who have a strong family history of breast cancer. Prevetive PM remains controversial, however. There are no randomized controlled trials to substantiate the potential benefit or harms of PM. This article describes the high-risk women in whom PM may be considered, and summarizes data on the efficacy of PM as a treatment for the prevention of breast cancer.