Background: More women with early-stage unilateral breast cancer and low genetic risk are opting for CPM, despite their low risk of developing cancer in their healthy breast and evidence to demonstrate that CPM improves neither survival nor quality of life, while increasing the risk of surgical complications. Little is known about the factors that motivate this irreversible decision. Methods: We conducted comprehensive qualitative interviews with 42 women at low risk for contralateral breast cancer (CBC) who had CPM in the last 10 years. We recorded and transcribed the interviews and analyzed them using a grounded theory approach. Results: Contrary to hypotheses that newly diagnosed women overestimate their CBC risk, study patients knew of the low risk of cancer in their healthy breast, but still chose CPM. Statistics were unpersuasive; given healthy lifestyles and lack of risk factors, they felt unlucky to get breast cancer and feared they would be unlucky again. They believed CPM would give them more peace of mind and the fewest regrets should cancer return. Avoiding mammograms was important, given the potential for callbacks, biopsies, and more bad news. Avoiding radiation and wanting matching breasts were cited less often. Most were mainly focused on reducing their cancer risk and could not recall having critical information about CPM’s potential harms. A few knew of likely harms but misjudged their impact. When told of CPM’s higher risk of complications, most dismissed this as a disclaimer, believing they would get through surgery well. Despite experiencing negative effects of CPM, 38 of 42 stated they would make the same decision again. Conclusions: When choosing CPM, most women felt confident in making their decision, although many had incomplete knowledge of potential long-term impacts. Nevertheless the majority of women who chose CPM did not regret their decision, suggesting that women who elect CPM are selecting a treatment option that is consistent with their long-term personal values and preferences. While important to ensure women know potential long-term harms, our findings suggest they may not necessarily be dissuaded from CPM by more data, though they may be better prepared for it’s aftermath.