The controversy surrounding the operation of prophylactic mastectomy, usually with immediate reconstruction, has been of interest to surgeons and oncologists for a number of decades but, in recent years, has become highly topical.1,2 In other areas of cancer management, prophylactic surgery has an established role. For example, in patients with the multiple endocrine neoplasia (MEN 2) syndrome and a mutation in RET, prophylactic total thyroidectomy is advocated to avoid the development of medullary thyroid carcinoma.3 Prophylactic colectomy is routinely advised in patients with familial adenomatous polyposis (FAP) syndrome to avoid the inevitable progression of colonic adenomas to invasive carcinomas;4 in patients with total ulcerative colitis with severe dysplasia on biopsy, the high risk of large bowel cancer is an additional reason for advising proctocolectomy in severely affected patients.