Purpose of the review <p>The objective of this review is to outline the indications for risk-reducing mastectomy (RRM) and pre-operative evaluation, and to understand the potential pathology findings in the breast specimens.</p> Recent Findings <p>Bilateral RRM is typically recommended for consideration in patients who are carriers of high-penetrance pathogenic germline variants, such as <i>BRCA1</i> and <i>BRCA2</i>. Benign lesions and high-risk lesions are much more commonly found in these RRM specimens. Several studies have found a very low risk of occult malignancy and even lower risk of sentinel lymph node metastasis at the time of RRM, and routine sentinel lymph node biopsy is not recommended in these cases. Few studies have looked at the feasibility and predictability of sentinel lymph node biopsy after a RRM when an occult invasive malignancy is found.</p> Summary <p>There is a low risk of finding occult malignancy in prophylactic mastectomy specimens.</p>