Is prophylactic mastectomy justified in women without BRCA mutation?

In the past decades the demand for prophylactic mastectomies has increased substantially. For healthy non high risk germ line mutation carriers there is no real objective justification for such a procedure, and screening according established evidence based guidelines is strongly advised. More demand for contralateral prophylactic mastectomy is coming from women diagnosed with breast cancer. First counseling and appropriate germ line gene mutation testing has to be established. In absence of high risk mutations, breast conservation therapy for the diagnosed breast cancer is as good as mastectomy, and the risk of a contralateral breast cancer is low (0.3-0.6% per annum follow up). So bilateral mastectomy will not provide any survival benefit and is associated with worsened body image and QoL, and more complications and re-operations as compared to breast conservation followed by screening. The patient asking for a CPM deserves careful counseling and a shared decision process.