Abstract: Nipple-areola complex sparing mastectomy is an improved surgical procedure that preserves the nip-ple-areola complex (NAC). This procedure is based on modified radical mastectomy techniques that retain thepectoralis major and minor. Theoretically, this surgical procedure achieves a favorable aesthetic and it en-sures a lower recurrence rate compared with breast-conservation surgery (BCS). NAC sparing mastectomy isrecommended for stage I and stage II breast cancer patients, especially for Asian women who have relativelysmall breasts. However, tumor invasion into the NAC has been an obstacle for the feasibility of NAC sparingmastectomy. Preserving the NAC carries a high risk of residual carcinoma remaining. It is necessary to pre-dict and estimate the risk of NAC involvement in breast cancer patients before surgery. Independent predic-tors including mammographic distance, pathologic stage, and tumor size were identified in patients with NACinvolvement. In this article we review the oncologic risks of and indications for NAC sparing mastectomy.