Patients who present for cosmetic breast procedures should be assessed for potentially increased risk of developing breast cancer and advised accordingly. The authors review the current information and clinical tools that will help plastic surgeons in identifying high-risk patients who would benefit from genetic testing and counseling. BRCA 1 and 2 mutations account for 5% to 10% of breast cancer cases. Women with high risk factors for BRCA 1 or 2 mutation should be referred to a medical oncologist and geneticist for counseling. A multidisciplinary approach is especially important in these cases, to provide counseling to patients regarding cancer risk, treatment options, and possible breast reconstruction methods. It is important for plastic surgeons to be involved in the treatment planning to discuss placement of biopsy and mastectomy incisions and also to adequately discuss realistic aesthetic expectations with the patient.