This case features a 61-year-old female diagnosed with a 1.9cm invasive ductal carcinoma of the left breast with widespread microcalcifications. She was clinically node negative and consented to a total mastectomy with sentinel lymph node biopsy. Traditionally a total mastectomy is performed by excising an ellipse of skin centered on the nipple with skin flap dissection using electrocautery. The result is a horizontal / oblique scar across the anterior chest wall, which can make applying a prosthesis or future breast reconstruction problematic. Often patients are left with an unsightly lateral 'dog-ear' due to excess skin / soft tissue in the axilla. In this video we demonstrate the steps for performing a 'sharp' mastectomy using a scalpel blade. By avoiding excessive use of electrocautery, electrothermic skin trauma is minimized. Infiltration of tumescence solution containing epinephrine prior to the initial skin incision minimizes blood loss associated with sharp dissection. This technique is applicable to all breast sizes or shapes and can be applied to skin / nipple-sparing mastectomy, and skin-reducing (Wise-pattern) mastectomy. An inframammary incision results in a relatively low scar on the anterior chest wall and maximizes preservation of upper pole skin for future prosthetic placement or autologous breast reconstruction. By extending the incision into the axilla, a sentinel node biopsy or axillary dissection is easily completed and the lateral dog-ear is minimized by advancing excess lateral skin anteriorly into this vertical component of the mastectomy incision. Importantly, this technique is easily learned, reproducible and does not require any specialized equipment.