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For patients who have an ipsilateral breast cancer recurrence following prior breast-conserving surgery and radiation, total mastectomy generally is recommended. However, little is known about the suitability and outcomes of nipple-sparing mastectomy (NSM) with immediate breast reconstruction for the treatment of recurrent breast cancer, prompting this investigation.From 1008 patients scheduled for NSM for breast cancer treatment at our institution between January 2009 and June 2016, we identified all patients who underwent surgery for ipsilateral recurrent breast cancer. We analyzed patient, tumor, and treatment variables, nipple preservation rates, and cancer outcomes.Twenty-one patients with ipsilateral recurrent disease were scheduled for NSM with immediate breast reconstruction, of whom 19 had received prior whole breast radiation. Two patients (10%) underwent intraoperative conversion to skin-sparing mastectomy for atypia or ductal carcinoma in situ in the central nipple ducts. Postoperative complications requiring intervention occurred in 2 patients: focal flap necrosis requiring debridement in 1 patient and seroma aspiration in another. Three patients received planned (pre- and/or postoperative) hyperbaric oxygen therapy. After 14.6 months median follow-up (range, 3-48.5 months), all 19 patients retained their native nipple-areolar complex and are disease-free.NSM may be performed in carefully selected patients with recurrent breast cancer, despite prior ipsilateral surgery and radiation, with successful preservation of the nipple-areolar complex and an acceptably low complication rate. Our data suggest no short-term adverse effect of NSM on oncologic outcomes.We identified 21 patients scheduled for nipple-sparing mastectomy (NSM) for ipsilateral recurrent breast cancer. Two patients underwent intraoperative conversion to skin-sparing mastectomy, whereas 19 had a NSM. Two NSM patients had complications requiring intervention. At follow-up, all 19 patients retained their native nipple-areolar complex and are disease-free. NSM may be appropriate for selected patients with locally recurrent breast cancer.