Background: Women with inherited high-risk breast and ovarian cancer genes or a strong family history benefit from risk-reducing surgeries. Combining prophylactic bilateral salpingo-oophorectomy (BSO) with deep inferior epigastric perforator (DIEP) flap harvest for breast reconstruction offers a single-stage approach to reduce cancer risk or treat breast cancer while concurrently reducing ovarian cancer risk. This study systematically evaluates the benefits of this combined approach in high-risk patients and ascertains whether robotic assistance further optimises outcomes. Methods: This single-institution retrospective observational cohort study included 59 female patients who underwent DIEP flap surgery between June 2019 and May 2025. Patients were grouped by surgical approach and staging. Demographics, intraoperative variables, postoperative outcomes, including patient-reported outcomes (PROs), were analysed using nonparametric tests. Results: Sixty-six percent of patients had a gene diagnosis, and 46% had a strong family history of either breast cancer, ovarian cancer, or both. Patients with a genetic mutation were significantly more likely to undergo risk-reducing surgery (p < 0.001). No significant differences were observed between groups in analgesia use, length of hospital stay, or complication rates. BREAST-Q scores showed improvements in Satisfaction with Breasts and Psychosocial Well-being postoperatively. Physical Well-being scores initially declined but improved over time as patients recovered. Robotic-assisted cases showed technical advantages and generally higher BREAST-Q scores, though not statistically significant. Conclusion: Combining BSO with DIEP flap breast reconstruction is safe and feasible for high-risk patients. Robotic assistance offers technical and patient satisfaction benefits, particularly in preserving abdominal wall integrity. Further research is needed to validate these findings.