Objective: To investigate the efficacy and safety of immediate breast reconstruction with extended latissimus dorsi myocutaneous flap after nipple-areolar-sparing mastectomy for breast cancer. Methods: The clinical data of 32 patients undergoing immediate breast reconstruction with extended latissimus dorsi myocutaneous flap after nipple-areolar-sparing mastectomy (observation group) and 34 patients undergoing conventional modified radical mastectomy (control group) in the Department of Surgical Oncology of the First Affiliated Hospital of Bengbu Medical College were retrospectively analyzed. The complications and outcomes between the two groups were compared and the postoperative breast appearances of the patients in observation group were analyzed. Results: There were no significant differences in age, tumor size and pathological stage between the two groups of patients (all P>0.05). The overall incidence of postoperative complications in observation group and control group showed no significant difference (37.5% vs. 32.4%, P>0.05). All patients were followed-up for 18 to 60 months with a median period of 44 months. Local recurrence occurred in 2 cases in observation group and 3 cases in control group, and distant metastasis occurred in 3 cases each in observation group and control group. The 3-year disease-free survival rate in observation group and control group showed no significant difference (87.5% vs. 91.2%, P>0.05). The excellent and good rate of the postoperative breast appearance was 90.6% in observation group. Conclusion: Immediate breast reconstruction with extended latissimus dorsi myocutaneous flap after nipple-areolar-sparing mastectomy is a safe and effective procedure, and it offers satisfactory postoperative breast appearance with no increase of the risks of complications as well as local recurrence and distant metastasis.