Goals: Breast reconstruction surgery has become a standard treatment to maintain cosmetic outcome for breast cancer patients. Skin sparing mastectomy (SSM) and nipple sparing mastectomy (NSM), which conserve the skin and nipple–areolar complex (NAC) covering primary tumor have better cosmetic outcome than conventional skin incision. However the evaluation of safety and prognostic impact of these procedure are under debate. Moreover SSM and NSM after neoadjuvant chemotherapy for locally advanced breast cancer patients is not evaluated prospectively yet. Methods: We enrolled locally advanced breast cancer patients who underwent SSM and NSM with reconstruction surgery retrospectively, and evaluated clinicopathological features and prognosis of these patients. Results: From October 2007 to May 2013, 144 patients underwent reconstruction surgery in Okayama University Hospital. SSM, NSM and conventional incision for reconstruction surgerywere 32 (22%), 82 (57%) and 30 (21%), respectively. 13 patients received NAC before surgery. Median age was 46 years (range 24–64) and median age of patients who underwent SSM, NSM or Bt was 45, 45 and 46 years. Reconstruction procedures were LD 58, DIEP 51, TE 33 and TRAM 2. Median tumor size of patients who underwent SSM, NSM and Bt was 2.3 cm, 2.2 cm and 2.0 cm (N.S.). There was one patient with nipple necrosis. 10/144 had recurrence, including one lymph node, one skin metastases and 8 distant metastases. There was no regional recurrence and two patients with NAC before surgery had distant metastases. Conclusion: Reconstruction after NAC for locally advanced breast cancer had no significant safety and prognostic risk. Disclosure of Interest: No significant relationships.