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We sought to determine whether patients undergoing contralateral, prophylactic mastectomy have greater anticipated and actual costs and financial burden than patients undergoing unilateral mastectomy, whether these financial considerations influence surgical decision making, and whether this affects satisfaction with surgical decision and overall quality of life.Female patients with unilateral breast cancer who underwent mastectomy at a large academic institution were surveyed regarding their financial experience surrounding the decision whether to undergo contralateral, prophylactic mastectomy.Of 109 patients approached, 101 completed the survey (response rate: 93%); 55 patients (55%) had contralateral, prophylactic mastectomy. Of the respondents, 16% reported that their decision was at least somewhat affected by anticipated costs. More patients opting for contralateral, prophylactic mastectomy had a “very large” anticipated financial burden than unilateral mastectomy patients (26% vs 9%, P=.037), but actual out-of-pocket costs and financial burden were similar between the two groups. Contralateral, prophylactic mastectomy patients, however, did not differ from unilateral mastectomy patients in their satisfaction with their decision nor quality of life, regardless of out-of-pocket costs or financial burden (P > .05).Although contralateral, prophylactic mastectomy patients are more likely to anticipate a “very large” financial burden compared with unilateral mastectomy patients, this does not seem to deter them from the contralateral procedure.