Diabetic mastopathy is a benign condition of the breast that typically manifests in patients with diabetes mellitus. Lymphocytic mastopathy is the term used to describe this condition in patients without diabetes mellitus. Most patients undergo excisional biopsy, but the use of mastectomy, even in cases of diffuse, bilateral disease, is rarely reported. We present a 32-year-old female patient with type 1 diabetes and bilateral diabetic mastopathy. Because of pain, and concern for limitations in future cancer detection, she underwent bilateral nipple-sparing mastectomies with immediate direct-to-implant reconstruction. A systematic literature review was performed to examine the treatment options for this disease, particularly from a plastic surgery perspective. Sixty articles were reviewed which contained information regarding 313 patients. Of these patients, only 4 underwent mastectomy. This case is the first report of bilateral nipple sparing mastectomy and immediate implant reconstruction for a patient with bilateral, symptomatic diabetic mastopathy.