The present study evaluated the oncological safety and technical outcomes following nipple areola skin-sparing mastectomy (NASSM), skin-sparing mastectomy (SSM), and mastectomy. Cosmetic issues associated with breast cancer surgery are important. The original SSM technique included removal of the gland and the nipple areola complex (NAC). However, the risk of tumor involvement of the NAC has been overestimated. This retrospective study included 520 patients who underwent SSM (368 patients) or NASSM (152 patients) with immediate breast reconstruction using a pedicled transverse rectus abdominis musculocutaneous (TRAM) flap, and 1990 patients who underwent a mastectomy between July 2001 and December 2006. The indications for NASSM were any stage, any tumor size, and any tumor areola distance. Briefly, the NAC was preserved when the shape, color, and palpation of the nipple were normal. The median follow-up durations for NASSM and SSM were 60 and 67 months, respectively. Complete nipple areola necrosis developed in 11 (9.6%) NASSM patients. The 5-year disease-free survival rates were 89% and 87.2% for NASSM and SSM, respectively (P = 0.695). The 5-year overall survival rates were similar for NASSM and SSM (97.1% and 95.8%, respectively; P = 0.669). Local failure occurred in 3 (2%) NASSM and 3 (0.8%) SSM patients (P = 0.27). There were 2 (1.3%) nipple areola recurrences in NASSM patients. The LRRs were similar for NASSM and mastectomy patients. NASSM with immediate transverse rectus abdominis musculocutaneous reconstruction is a viable surgical treatment in breast cancer patients in any stage. Recurrence and complication rates for NASSM were similar to those for standard surgical breast cancer treatments.