Total mastectomy, as practiced today, discourages preservation of the nipple-areolar complex (NAC) because surgeons have had long-standing concerns about possible neoplastic involvement and postoperative viability of the NAC. Previously published studies1- 8 that considered neoplastic involvement of the NAC often involved retrospective pathological analysis of preserved mastectomy specimens. Reported rates of neoplastic involvement of the NAC varied from 0%7 to 58%.8 Furthermore, some studies adjusted for the likelihood of NAC involvement after correlation with additional possible predictive indicators, including node status,3,4,6,9- 13 tumor size and location within the breast,1- 5,7,9- 17 nuclear grade,2- 5,10,13,15,18 and multicentricity or multifocality.3,5,8,9,13,16 Although most of these studies agreed that neoplastic involvement of the NAC was more likely when tumors were centrally located or greater than 2 to 3 cm in diameter, relative findings were inconsistent and, therefore, prohibitive to a definitive consensus. However, with the success of skin-sparing mastectomy,18- 21 it became possible to consider nipple-sparing mastectomy (NSM), skin-sparing mastectomy combined with preservation of the NAC, and immediate reconstruction. The purpose of this study was to develop and describe an experience with NSM, with particular attention to neoplastic assessment of the NAC, surgical technique, and sustained postoperative NAC viability.