A 51-year-old woman with a pathogenic ATM mutation and severe hypertrophic cardiomyopathy (NYHA III-IV, ASA IV) underwent bilateral nipple-sparing risk-reducing mastectomy under awake thoracic regional anaesthesia using bilateral erector spinae plane and intertransverse process blocks with conscious sedation. This evidence concerns the gene ATM and hypertrophic cardiomyopathy.