Studies have shown that breast conserving surgery is as efficacious as mastectomy in the treatment of women with early stage breast cancer. Recent publications, however, have demonstrated an increasing number of women electing bilateral mastectomy when diagnosed with unilateral breast cancer. Several plausible reasons for this rising trend for bilateral mastectomy include increased awareness of breast cancer risk in the contralateral breast, increased use of breast MRI as a diagnostic tool and advances in reconstructive and mastectomy techniques. This review will focus mainly on the reconstructive options within the third probable reason for the increasing trend of bilateral mastectomy, advances in breast reconstruction and mastectomy techniques. The various options in breast reconstruction will be presented with a historical perspective, as well as a brief discussion on current mastectomy techniques in breast surgical oncology, as advances in both fields have likely influenced the rising trend of bilateral mastectomy in the United States.