In breast cancer 1 (BRCA) gene mutation carriers, mastectomy is still the mainstay of treatment for breast cancers due to the increased risk of local recurrence. It is performed as a therapeutic, as well as prophylactic procedure. However, mastectomy with removal of nipple areolar complex (NAC) is associated with adverse cosmetic outcome. NAC sparing mastectomy (NSM), which results in better cosmetic outcome, has been performed in non-BRCA mutation carriers. While studies have shown that NSM is a oncologically safe in sporadic breast cancers, its application in BRCA mutation carriers is still controversial. Here we review the existing evidence of NSM and its application in BRCA mutation carriers.