BACKGROUND: Preservation of the nipple areolar complex (NAC) provides the optimal conditions for immediate breast reconstruction (IBR). Growing evidence suggests the oncological safety of nipple sparing mastectomy (NSM) when neither NAC nor skin is affected by tumor. This paper presents our initial experience performing NSM and IBR in a selected group of patients through the inframammary incision assisted by hydrodissection. MATERIAL AND METHODS: The study includes 20 healthy women, aged 23-53, and referred for bilateral risk-reducing mastectomy. NSM was carried out using inframammary crease incision assisted by hydrodissection followed by IBR with an acellular dermal matrix (ADM) and an implant as presented in the attached video. Exclusions criteria were hypertension, diabetes, active smoking and previous chest radiation therapy. Data was collected retrospectively. RESULTS: We achieved the reconstructive goal for all 40 breasts (100%). There were no cases of NAC necrosis. Minor complications were registered in two reconstructions (5%), including one case of small partial necrosis and one case of wound dehiscence. The median follow-up was 13 months (range, 1-32 months). CONCLUSIONS: Bilateral risk-reducing NSM and IBR can be successfully achieved through an inframammary crease incision assisted by hydrodissection. Patient selection is the key to a successful outcome.