Lumpectomy or partial mastectomy involves removing the tumor with a margin of normal tissue under the guidance of an intra-operative Pathologist. In many instances this would be sufficient, however on occasion it is necessary, due to the size of the defect or the position of it on the breast (for example: the area of the decolletage and around the nipple), to reconstruct this defect by either cosmetic surgery technigques or reconstructive techniques which may or may not involve the opposite breast in order to leave you with a pair of similar sized and shaped breasts after surgery.

Techniques could include:
Breast reduction approaches to the breast tissue thourgh a keyhole type incision. The tumour is removed along with surrounding normal breast tissue. Subsequent to the report of clear margins reconstruction of the breast mound is commenced. The aim of this is to achieve a normal looking breast mound and nipple areaola complex. The opposite breast then undergoes a similar process to obtain symmetry. The ideal result is obtrained in women who have slightly larger breasts. In these cases we would hope to attain a pleasing breast mound with the nipple above the fold below the breast and sited at between 18 to 24 cm from the notch of the breastbone.

The main disadvantage of this approach is scarring around the nipple on the lower part of the breast and in the fold. This scar resembles and anchor and may be initially angry and red and take up to a year to mature to a white flat scar.

In cases where the breasts are not large enough to allow the above approach, tissue from elsewehere would need to be imported into the defect. The most common donor site for these cases is the skin fat and muscle from the back.

This process involves taking an island of skin and fat from the back and basing it on the latissimus dorsi muscle, the fan shaped muscle which extends from the armpit to the top 12 vertebrae, using the blood supply which enter the muscle in the armpit. The entire block of tissue is raised and brought around to the front of the chest and inserted into the defect left by the surgery. As this tissue has its own blood supply, which is retained, during surgery it is known as a flap not a graft. The advantage of this flap is that is has very little problems in dealing with readiotherapy, which would follow.

All flaps add some risk to the procedure, as anything which compromises the flow of blood to the transported tissue, may increase the risk of complications. Smoking, arterial disease, obesity, low blood pressue and conditions with abnormal clotting can all increase the potential for complications.

The final result of the latissimus dorsi flap may involve some back skin on the chest wall as well as a scar on the back, which should be able to be concealed by the bra or costume strap.

Complete mastectomy with reconstruction
Mastectomy is an operation used to treat breast cancer and other breast diseases in which the nipple pluys an amount of skin and virtually all the breast tissue is removed. In some cases the underlying pectoralis muscle may also need to be removed.

Breast reconstruction following mastectomy is a complex field involving many choices based on some of the following criteria of risks/benefits as well as integration with the rest of the treatment plan:

	Type and extent of mastectomy.
	Previous surgery / radiation to breast.
	Size and shape of opposite breast.
	The need for post-operative radio or chemotherapy.
	Potential donor sites for tissue transfer on patient's own body.
	Age, medical conditions and anaesthetic risk of the patient.
	Preferences and /or fears with regards silicone and certain procedures.

Having read the above you will see that certain options may not have been made available to yourself. This is due to the fact that they have been deemed as technically not viable due to either the nature of your mastectomy, underlying conditions you maight have or an inability to integrate those options in a realistic post operative plan.

The other reason may be that either previous surgery or the current mastectomy may damage the blood supply to the tissue needed to be transferred during the reconstruction. I will shortly explain briefly what the operation are to re-cap on the consultation.