The blood supply of nipple-areola complex (NAC) can be divided into five regions: the internal, external, upper, lower and central regions. The upper internal region is the main blood supply source. Most of the source vessels are the branches of the internal thoracic artery and the lateral thoracic artery. Totally 96% of the breasts demonstrate anatomically symmetrical patterns of blood supply for bilateral NACs, but an asymmetrical pattern of bilateral breast blood supply is demonstrated in nearly half of the females with breast hypertrophy. In nipple-sparing surgery, postoperative necrosis of NAC is a severe complication. Preoperative angiography or enhanced magnetic resonance imaging can be used to evaluate the blood supply of nipple-areola area. The success of oncoplastic breast surgery, breast reconstruction and reduction mammaplasty depends on the understanding of NAC blood supply. If a periareolar incision is necessary, a lower periareolar incision is preferred to preserve blood supply under the dermis by removing the epidermis around the areola and make up for the deficiency of the periareolar incision. In addition, the influence of smoking, diabetes, obesity, hypertension and previous surgical scars on the blood supply of nipple areola should be fully evaluated.