INTRODUCTION: Nipple-sparing mastectomy is an oncologically validated technique for selected breast cancer patients and allows to improve aesthetic results and patients quality of life. Conventional skin incisions are often a suboptimal solution due to the visibility of the scars. Aim of this work is to show our innovative technique, which allows to perform nipple‐sparing mastectomy, lymph-node surgery, and endoscopic immediate prosthetic breast reconstruction using a single cosmetic axillary incision. MATERIALS AND METHODS: Between June 2016 and October 2019, 14 consecutive patients underwent therapeutic nipple‐sparing mastectomy with endoscopic immediate reconstruction via axillary incision; inclusion criteria were cup A or B breasts and tumors less than 3 cm in diameter. Data were recorded in order to evaluate reproducibility, feasibility, safety, aesthetic outcomes and patients quality of life. RESULTS: Mean age was 46 years old (range: 34‐54 years); median tumor size was 1.7 cm; average follow‐up time was 11 months (range 3-42); median operation time was 340 minutes; mean hospital stay was 4,1 days. Tumor‐free margins were obtained in all 14 cases. No local-regional recurrence occurred during follow‐up. No major complications were experienced. No systemic complications were observed. All patients were satisfied with their aesthetic results, especially the absence of visible scars. CONCLUSIONS: Therapeutic nipple‐sparing mastectomy with endoscopic immediate prosthetic reconstruction via axillary incision is a safe and appropriate procedure in cup A and B breasts, alternative to conventional techniques. It allows to improve aesthetic outcomes and patients quality of life thanks to a single well-hidden axillary scar.