Objective: To investigate the safety and surgical techniques of immediate breast reconstruction using an extended latissimus dorsi myocutaneous (LDM) flap following modified radical mastectomy with nipple-areolar complex (NAC) preservation. Methods: Twenty-eight patients with early-stage breast cancer underwent the modified radical mastectomy with NAC preservation, and then immediate breast reconstruction using an extended LDM flap was performed. Some technical modifications were adopted during surgery, including the protection of the sensory nerves of breast skin, preservation of the thoracodorsal nerve and its second branches, turnover flap for breast restoration, filling of the axillary defect, reconstitution of the anterior axillary fold, and ample bulk of the flap (equal to more than 20–50 percent of the glandular mass resected). Results: The immediate breast reconstruction was successfully performed in all of the 28 patients. All patients were alive and with no local recurrence during the follow-up period of 12–36 months. One patient had bone metastasis 10 months after operation and another case experienced bone metastasis 2 years later. The cosmetic results were excellent in 18 cases, good in 6 cases, fair in 2 cases and poor in 2 cases, respectively. The reconstructed breasts showed the presence of skin sensation and nipple erection function, with natural ptosis, symmetrical appearance with the contralateral breast and well-filled axillary space. In addition, this procedure conferred an obviously larger range of movement in the ipsilateral arm compared to that after conventional modified radical mastectomy. Conclusion: For appropriately selected patients, it is safe and effective to perform immediate breast reconstruction with extended LDM flap after modified NAC-sparing radical mastectomy. Some rational technical modifications of the procedure can improve the quality and aesthetics of the reconstructed breast.