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Patients to be considered for prophylactic mastectomy fall into two groups. The first group comprises those who have already had a mastectomy and are either contemplating reconstructive surgery or are concerned about the development of cancer in their remaining breast. Since the patient who has had a mastectomy and is interested in reconstruction is already in a high‐risk group, she has discussed at the initial interview, the possibility of prophylactic mastectomy and reconstruction. The second group of patients considering a prophylactic mastectomy also fall into the high‐risk group. They have not yet had a mastectomy but find that they are emotionally disturbed by the constant finding of new masses, and many have also had a number of biopsies. The patients in the second group are usually referred by a physician or surgeon who has followed them for a long period of time, or they have come on their own because of their mental anguish. It is the second group of patients, especially, who need time to have discussed with them in detail all our current knowledge concerning their high‐risk status. However, both groups of patients must on their own, after counseling, make the final decision whether or not to have a prophylactic mastectomy.