A 43-year-old, gravida 3, para 3, with a known BRCA1 gene mutation presents to the office to discuss risk-reducing surgery. Her family history is significant for breast cancer diagnosed in her mother at age 42 years, ovarian cancer in a maternal aunt at age 53 years, and ovarian cancer in her maternal grandmother at age 49 years. Last month, she underwent genetic counseling and testing revealed a BRCA1 mutation. She is otherwise healthy with no significant past medical history or surgical history. She had three uncomplicated vaginal deliveries and has regular monthly periods. She used oral contraceptive pills for birth control for 15 years prior to her husband’s vasectomy. She denies any recent weight change, fever or chills, bowel or bladder dysfunction, nausea, early satiety, or abdominal or pelvic pain. She had a normal mammogram last week. She is not taking medications and has no known drug allergies.