Nipple-sparing mastectomy (NSM) is a widely accepted surgical technique for patients with early breast cancer. The technique improves cosmetic outcomes, but a decrease in nipple sensitivity has been observed with NSM because of the incision into the nipple-areola complex (NAC). Endoscopic nipple-sparing mastectomy with skin lifting system (ENSMSLS) removes all breast tissue through the axillary incision used for the sentinel lymph node biopsy, to avoid incision around the NAC area. With only one incision, NAC sensitivity is less likely to be affected by this technique. We sought to investigate the effect of ENSMSLS on sensation in the NAC, compared with NSM.A single-institution retrospective review was performed from August 2014 through August 2015. Thirty patients who underwent NSM in the past 6 years were frequency matched for age and cancer stage with those who underwent ENSMSLS between 2014 and 2015. All patients were recalled and re-examined for the study. Patients from the ENSMSLS group were recalled twice at both 3 and 6 months after surgery. Matched control subjects who underwent NSM were examined when they were recalled. The sensations of pressure, temperature, and vibration were measured.Patients who underwent ENSMSLS were significantly less likely to have decreased or impaired sensations of pressure, temperature, and vibration compared those who had NSM. The improvement in preservation of sensations by the use of ENSMSLS was very impressive.ENSMSLS, which avoids incision around the NAC, significantly decreases the possibility of decline in NAC sensation.