Objective To investigate the clinical efficacy, complications, and cosmetic results of reserving the nipple-areola complex (NAC) and immediate breast reconstruction for early breast cancer patients.Methods A total of 58 cases of breast cancer (0 -Ⅱa stage) were retrospectively reviewed in the Department of Surgical Oncology, Fujian Provincial Hospital from June 2010 to June 2014.Of these patients,32 cases underwent nipple-areola complex sparing mastectomy (NSM) and immediate breast reconstruction(observation group), and the other 26 cases underwent modified radical mastectomy and immediate reconstruction (control group).The reconstruction was performed using a prosthetic implant, covered with dorsal latissimus free flap. The local recurrences, distant metastasis, complications and cosmetic outcomes were compared.Results The follow-up time ranged from 48 to 60 months with a mean of 52.36±3.51 months. No local recurrence was found in the two groups. One case of distant metastasis occurred in both the observation group and control group, and there was no significant difference (P>0.05). The postoperative complications were found in 11 cases of the observation group and in 7 cases of the control group, respectively, but there was no significant difference (P>0.05). For the observation group,the number of cases rated as excellent, good, not bad, and bad levels of cosmetic outcomes were 26, 5, and 0, respectively, and for the control group, the number was 6, 14, 6, and 0, respectively;the cosmetic outcomes of the observation group were significantly better than those of control group (P<0.05).Conclusion Nipple-areola complex sparing mastectomy and immediate breast reconstruction contribute to achieving better aesthetic and functional results, also providing a cosmetic and quality-of-life benefit for patients selected by strict preoperative selection criteria and following strict operative procedure.