OBJECTIVE The objective was to analyze the frequency and factors influencing necrotic complication in female patients undergoing nipple- and areola-sparing mastectomy. Nipple- and areola-sparing mastectomy has recently been shown to yield satisfactory results in a carefully selected group of breast cancer patients. The technique includes extensive undermining of the nipple-areola complex, which may result in an increased rate of necrotic complications. We report our early experience with necrotic changes after nipple- and areola-sparing mastectomy. METHODS The medical records of 38 patients undergoing nipple- and areola-sparing mastectomy were analyzed retrospectively. RESULTS Mean age of the patient was 44.5 years (range 26-65). Necrotic complications occurred in 15.8% of patients and included: skin flap necrosis (1 case), partial nipple-areola complex necrosis (2 cases), and complete nipple-areola complex necrosis (3 cases). Two cases of capsular contraction were also recorded. Statistical analysis showed age below 45 years to be associated with a lower risk of necrotic complications (OR 4.51, P<0.05). CONCLUSIONS The nipple- and areola-sparing mastectomy, although resulting in a relatively high frequency of necrotic complications, is a valuable surgical option for patients with small, peripheral tumors and for women undergoing prophylactic mastectomy. The procedure seems to be safer for women under 45 years of age.