Breast conserving surgery (BCS) with adjuvant radiotherapy (RT) confers an equivalent 20 year survival rate to mastectomy. Concerningly, 15% of BCS patients do not receive RT. Several barriers to completing RT have been described. However, non-compliance with post-BCS radiotherapy due to severe claustrophobia is not well documented in the literature. We report the case of a patient who declined radiotherapy following BCS due to severe claustrophobia. With advances in oncoplastic breast surgery, completion nipple-sparing mastectomy (NSM) may be an alternative to simple mastectomy in BCS patients unable to undergo RT. NSM is an oncoplastic procedure that involves attaining complete oncologic resection whilst sparing the nipple-areolar complex. Recent literature highlights that NSM has more favourable aesthetic outcomes and improves quality of life compared to simple mastectomy. This report further describes the novel use of NSM and reconstruction for the case patient and highlights its potential use in patients who are unable to undergo neoadjuvant RT.