Background: Determination of BRCA1and 2 mutation carrier’s status has become increasingly important. BRCA1/2 carriers are offered bilateral mastectomy (BLM) and prophylactic oophorectomy. Those who test negative typically do not undergo such extensive surgery. However, there is a cohort of women who still decide to have BLM at the time of their breast cancer diagnosis despite testing negative for the mutation. A questionnaire was sent to women who had prophylactic mastectomies to determine the reasons for their surgical choice. Methods: Women who received BRCA1 and 2 testing and tested negative but chose bilateral mastectomies between January 2005- May, 2010 were sent a questionnaire. For those who expressed an opinion, a two-sided Fisher exact test was used to compare responses. Patient demographics, family history, reasons for choosing mastectomy, and satisfaction were recorded. Results: A total of 35 surveys were mailed, and 28 were returned (80%). The mean patient age at diagnosis was 41.9 years. The majority of women were Caucasian, had some college to postgraduate education, and had children. 64% had a relative with breast cancer. Fear was the main reason why these women choose BLM. The majority had breast reconstruction and overall 71% were very satisfied with their surgical choice. Conclusions: Increased rates of contralateral prophylactic mastectomies have been observed in women with negative BRCA results. In our study Caucasian, educated, married women were more likely to choose BLM. The main reason women gave for choosing BLM was fear of recurrence. Prospective studies are needed to examine factors effecting patient decision-making.