Review of nipple sparing total mastectomies (NSTM) performed by a infra-mammary incision (INF), or nipple graft for larger breasts and reconstruction with sub-muscular tissue expanders is presented. The lateral border was closed with Alloderm. Botox 100 IU was injected IM for spasm. After expansion a saline implant was used. 61 patients had 101 NSTM. 76 performed through INF incision. 28 larger breasts required a nipple graft. 50 for malignancy and 46 for prophylaxis. 14 (13.9%) developed necrosis; 7 (9.6%) with INF incision and 7 (25%) with nipple grafts. 6 healed by second intention, 4 by resection and closure, 2 by a stsg and 1 expander extrusion. Epidermolysis 7 (6.93%). Hematomas 1 (0.98%), seromas 4 (3.96%), infection that required removal of expander 1 (0.98%), cellulitis subsided with antibiotics 3 (2.97%), expander malfunctions 6 (5.94%). Implant failures 1 (1.4%). Total complications 38 (37.6%). Capsulotomies 28 (39.4%) and capsuloplasties 3 (4.2%). Average implant volume 497cc. Patient satisfaction 8.7 on a scale of 1-10. Average follow-up 12.3 months. No malignancy recurrence. NSTM allowed reconstruction that coincides the patient's desired volume, with great satisfaction. Longer follow-up period is necessary to evaluate oncologic efficacy. Complications were of minor degree and the cosmetic results minimally affected.

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