Bilateral prophylactic mastectomy lowers the risk of developing breast cancer in high-risk patients and hereditary breast cancer by more than 95%. Therefore, in selected cases bilateral prophylactic mastectomy represents an effective procedure for breast cancer prevention and, when combined with modern plastic-surgical techniques of breast reconstruction, can achieve good to excellent cosmetic results and high patient satisfaction. Diligent decision making including an accurate determination of the individual risk profile is mandatory. In case of ethical conflicts that may arise in this context, a clinical ethics consultation can be a helpful tool in establishing a sustainable consensus between patient and treating physician.