Breast cancer is the most common cancer diagnosed in women. Nipple-sparing mastectomy (NSM) offers the opportunity to preserve the breast envelope and the nipple-areolar complex by removing only breast tissue and avoiding multiple surgical procedures for reconstruction. The objective of this article is to review the oncologic and surgical concerns with NSM, along with the appropriate selection of patients and potential postoperative complications. A review of the literature was conducted through MEDLINE®, PubMed, and Google Scholar, focusing on recent research. The findings revealed that although the oncologic safety of NSM continues to be debated, indications are strong that cancer recurrence rates are low and the aesthetic motivation is high for carefully screened patients. From those findings, considerations for patient education regarding risks and expectations are described. Nurses in a variety of cancer care settings can use this information to address the concerns of patients making decisions regarding surgical options and adjusting to postoperative body image expectations and changes.