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This 66-year-old woman presented to my office to discuss prophylactic mastectomy. During her evaluation, I assessed the position of the nipple-areola complex and its distance from the clavicle. Based on these findings, there was concern that the length of the tissue could compromise the blood supply to the nipple-areola complex if nipple preservation was attempted at the time of mastectomy. We discussed a staged approach, beginning with a breast reduction prior to mastectomy. This first-stage procedure shortened the distance to the nipple-areola complex and optimized its blood supply, increasing the likelihood of safely preserving the nipple during the subsequent prophylactic mastectomy.