Purpose of Review <p>Population-based incidence rates of breast cancer are increasing in young/premenopausal women. Genetic testing panels are expanding and identify larger subsets of women with hereditary susceptibility for breast cancer. Options for primary prevention of breast cancer as well as fertility preservation among newly diagnosed patients are therefore becoming more relevant for young women. This review summarizes advances in these strategies.</p> Recent Findings <p>Primary surgical prevention of breast cancer is feasible via prophylactic mastectomy (at any age) or prophylactic removal of the ovaries (in premenopausal women), with prophylactic mastectomy being the most definitive and effective. Improved breast reconstruction and the nipple-sparing mastectomy approach have increased the acceptability of prophylactic mastectomy. Since microscopic foci of breast tissue remain present in the subcutaneous fat of the mastectomy skin flaps (regardless of whether the nipple has been preserved or not) women choosing prophylactic mastectomy surgery must be informed of their residual lifetime risk of developing breast cancer. A variety of fertility preservation options are available and safe in women that are diagnosed with breast cancer or that have high future risk of breast cancer. Unfortunately, these options often incur substantial out-of-pocket expenses. Completing a pregnancy after a breast cancer diagnosis is also safe.</p> Summary <p>Young women can choose between several alternatives for reducing breast cancer risk and preserving their fertility/family planning options. Further research is warranted regarding expanded access to these important survivorship options.</p>