Purpose of Review <p>The use of prophylactic mastectomy (PM) as a surgical strategy in women at high risk for breast cancer but without a pathogenic gene mutation remains a contentious issue. Although rates of contralateral prophylactic mastectomy (CPM) have risen, evidence supporting its survival benefits in this population is limited.</p> Recent Findings <p>This review examines current data on the efficacy, psychosocial impact, and clinical considerations of offering PM to high-risk women without pathogenic mutations. Key studies highlight minimal survival advantages, significant psychosocial drivers of the decision-making process, and the role of shared decision-making in aligning clinical practice with patient-centered care.</p> Summary <p>Undergoing prophylactic mastectomy in patients without a specific gene mutation is a complex and individual surgical decision between the patient and practitioner that hinges upon many factors such as family history, psychosocial elements, cancer biometrics, and national guidelines. Future research must address the psychosocial and quality-of-life outcomes associated with PM to refine recommendations and support evidence-based counseling practices.</p>