The effort to reshape and improve the breast through injected substances has become a significant public health issue, resulting in mortality, morbidity, and considerable healthcare costs. As physicians, we find ourselves increasingly being called to deal with problems generated by injection-induced breast siliconomas: symmastia, challenging masses that are often confused with advanced breast cancer, etc. To this is added the extreme difficulty of ruling out breast cancer through physical examinations, mammography, ultrasound, and even magnetic resonance imaging (MRI). Each treatment plan must be meticulously designed. This chapter describes the techniques employed by the senior author, which include risk-reducing mastectomy and reconstruction using cosmetic remodeling techniques. These techniques aim to reduce the risk of breast cancer in a “silent breast” by attempting to preserve or restore breast anatomy. The surgical technique involves an open resection utilizing various extents of breast reduction pattern incisions. This approach has consistently yielded satisfactory results, leading to a risk-reduction mastectomy, a reduction in both local and systemic symptoms, a decrease in autoimmune markers, and notable psychological and social improvement. We advocate for the direct open excision and reshaping of the breast form through strategically placed incisions along the boundaries of aesthetic units.