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Nipple-preserving mastectomy and immediate reconstruction has further improved the aesthetic outcome of skin-sparing mastectomy. To investigate the effect of the type of reconstruction technique on aesthetic outcome, three different methods of reconstruction were compared using four evaluation modalities.Sixty-one cases of nipple-sparing envelope mastectomy with immediate reconstruction were studied, with a mean follow-up of 48 months. The methods of reconstruction used were implant-only reconstruction, pedicled latissimus dorsi muscle with implant, and deep inferior epigastric perforator flap. Evaluation methods were objective applanation tonometry, clinical evaluation, photography-based assessment, and patient satisfaction survey.All three reconstruction methods achieved good evaluation scores in the four modalities. However, in patients who had postoperative radiotherapy, objective tonometry showed that the breast remained softer in deep inferior epigastric perforator flap reconstruction.In patients who are undergoing nipple-preserving envelope mastectomy with immediate reconstruction and who are likely to have postoperative radiotherapy, deep inferior epigastric perforator flap reconstruction achieved a better aesthetic outcome.