Women who have a mastectomy for cancer and must consider the possibility of a simultaneous prophylactic mastectomy and reconstruction at the time of reconstruction of the mastectomized breast have a variety of reactions. The reactions of the women in this study ranged from terror and reluctant acceptance to eagerness to be rid of future threats of cancer. This paper describes the stages of telling the patient, reactions to anticipated loss, and the postoperative reactions to the second mastectomy. For some the second mastectomy relieved fears about developing cancer; others found the idea devastating but still acceptable. The majority more readily assimilated the immediately reconstructed breast into their body image. Immediate reconstruction appears beneficial in easing the pain of an inevitably difficult experience.