Background: There are two widely accepted procedures that are used to surgically treat cancer of the breast while preserving the nipple & areola complex (NAC); breast conservative therapy (BCT) using oncoplastic procedures (OPS) and nipple sparing mastectomy (NSM) with immediate reconstruction. Not many studies directly compare the two methods. It is especially important to compare these methods in studies specifically targeting the Egyptian population, due to different tumour biology, different radiotherapy technique, and different body habitus. The goals are to compare NSM with autologous reconstruction versus oncoplastic breast surgery regarding the aesthetic and oncologic results. Patient and methods: The present study was conducted on 30 patients with Stage I and II breast cancer as well as having tumors located within the breast tissue more than 2 cm away from the areola. The patients were subjected to either OPS techniques (local tissue rearrangement or reduction mammaplasty techniques) or NSM with autologous reconstruction (Latissimus Dorsi Flap). Long term assessment was carried on after 3 months including patient and doctor satisfaction. Results: Fifteen patients were surgically managed by OPS and fifteen by NSM. All 30 cases in the study showed an overall good acceptance of the surgery, however they were all concerned about the possibility of recurrence of the disease i.e. they are satisfied regarding the cosmetic effect but still worried about the oncological aspect of the disease. As a single breast its size, shape, contour, and NAC position and direction are satisfactory however due to patient refusal of contra-lateral symmetrization the overall cosmetic outcome may appear unsatisfactory to both, patients and plastic surgeons. Conclusion: Oncoplastic breast surgery (OPS) and Nipple sparing mastectomy (NSM) are both safe and aesthetically accepted, however with OPS patients have to receive breast radiotherapy with all its complications. In many cases, this will affect the aesthetic result. Patients are becoming increasingly worried about developing a cancer in their breasts amidst a rising general perception of increased breast cancer incidence. This in turn has led to an increased interest in prophylactic mastectomies. Through immediate reconstruction, NSM offers patients the possibility of maintaining an aesthetic breast while removing all the tissue liable to develop a malignancy in the breast. Keywords: Breast cancer, nipple sparing mastectomy & oncoplastic breast surgery, immediate breast reconstruction.