Purpose: The purpose of this study is to evaluate clinical outcomes and satisfaction in patients who have undergone prophylactic mastectomy and breast reconstruction. Methods: A five-year retrospective analysis of the senior author's experience with breast reconstruction following prophylactic mastectomy was performed. Timing, type of mastectomy and reconstruction, complications, and cancer occurrence/recurrence were examined. Patients were asked to grade their level of satisfaction on a 6 level scale. Aesthetic outcomes were also graded on a 4 point scale by a group of surgeons. Results: 74 patients underwent 101 breast reconstructions following prophylactic mastectomy. During a mean follow-up of 31months, 10 complications occurred (10% of breasts). 47 patients in the study had undergone unilateral prophylactic mastectomy. In this group, the number of complications found on the cancer reconstruction side was 13 (28% of breasts). Patient satisfaction and surgeon ratings were higher in the bilateral prophylactic patients compared with the cancer patients who had undergone a unilateral prophylactic mastectomy. Conclusions: Breast reconstruction following prophylactic mastectomy has a lower incidence of complications than following oncologic mastectomy. It also appears that patient satisfaction and aesthetic outcomes are more favorable in bilateral prophylactic mastectomy and reconstruction patients when compared with unilateral prophylactic mastectomy and reconstruction patients.