Skin sparing mastectomy is a relatively new technique based on the fascial anatomy of the breast. It removes the breast, nipple-areola complex, previous biopsy incisions, and skin overlying superficial tumors. Preservation of native skin and the inframammary fold greatly enhances the aesthetic result of breast reconstruction. The operation has been adopted for patients with early breast cancer treated by total mastectomy and immediate reconstruction, but has received little attention in the general surgery literature. The anatomical and technical aspects of skin sparing mastectomy are described.