Background <p><i>BRCA1/2</i> genetic testing has become essential in breast cancer management, guiding surgical decisions, surveillance, and targeted therapies. While it has revolutionized personalized medicine, challenges remain in its implementation.</p> Objective <p>This review summarizes the impacts of <i>BRCA1/2</i> genetic testing on surgical choices and risk-reducing strategies, plus its role in the therapy of PARP inhibitors.</p> Methods <p>We analyzed recent studies, clinical guidelines, and meta-analyses focusing on the clinical utility of <i>BRCA1/2</i> genetic testing in breast cancer management.</p> Results <p>Breast-conserving therapy (BCT) does not conclusively impact survival in <i>BRCA1/2</i> mutation carriers, making it a viable option for those preferring breast conservation. The benefit of contralateral risk-reducing mastectomy remains uncertain, but it may be considered if the patient understands the risks and benefits. Risk-reducing salpingo-oophorectomy effectively prevents ovarian and fallopian tube cancers and improves survival. MRI is superior to mammography for early cancer detection in high-risk women and is beneficial for surveillance when contralateral mastectomy is not performed. <i>BRCA1/2</i> testing is also essential for determining eligibility for PARP inhibitor therapy, particularly olaparib, which has shown efficacy in early breast cancer patients with <i>BRCA1/2</i> mutations in the OlympiA trial.</p> Conclusion <p><i>BRCA1/2</i> genetic testing enhances personalized breast cancer treatment but presents challenges in patient selection, decision-making, genetic counseling, and insurance coverage. A multidisciplinary approach is essential for shared decision-making and improved outcomes in <i>BRCA1/2</i> mutation carriers.</p>