The implementation of plastic reconstructive procedures expands the scope of breast conservative surgery to encompass more and more patients with different tumors\breast size relations and additionally improves the final aesthetic outcome. Reconstruction by a standard latissimus dorsi flap or local glandular flap can be done following lumpectomy and axillary clearance when such procedure results in obvious aesthetic deformity or marked asymmetry in comparison to the contralateral breast, the surgeon is often left with a mandate to either restore the shape and contour of the operated breast or to reduce and symmetries the contralateral breast. Skin sparing mastectomy with or without NAC preservation offer a good alternative option for patients with breast cancer who are not candidates for lumpectomy. One of the corner stones for success of breast reconstruction is the preservation of skin envelope and also NAC if possible in selected cases. If NAC can not be preserved, reconstruction of these elements should be considered. A symmetrizing procedure on contralateral breast is occasionally necessary and should form part of initial evaluation and planning. The surgical management of breast cancer has been dramatically changed from radical mastectomy to conservative breast surgery and skin sparing mastectomy according to the patients’ indications. The most recent variation of skin sparing mastectomy is NAC preservation in certain situation. In summary, we believe that lumpectomy or skin sparing mastectomy with or without NAC preservation followed by immediate reconstruction is the best option for women with breast cancer nowadays.