In the past 10 years our knowledge of hereditary breast cancer, and specifically the breast cancer susceptibility genes BRCA1 and BRCA2, has dramatically increased, as has our understanding of prevention options for high-risk women. Effective strategies to reduce the risk of breast cancer include prophylactic mastectomy, prophylactic oophorectomy, and chemoprevention. In this article we review the current evidence regarding the efficacy of each of these management strategies.