Case 1 Background information:A lady in her 50s was found to have right breast ductal carcinoma in-situ, which is a “pre-cancerous” stage of breast cancer on a screening mammogram. She did not have any symptoms or complaints related to the breast. There was also no change felt in the breast – the breasts felt like normal to her. As a result of the finding of suspicious calcifications on her screening mammogram, she was referred for a needle biopsy of the calcifications. On confirmation of the diagnosis by examining the cells in the samples taken by needle sampling of the part of the breast concerned (under mammographic guidance, since no abnormality could be felt on the breast), the discussion and planning of type of surgery with both her breast surgeon and a plastic surgeon was done. As her type of cancer was usually present in more than 1 spot in the breast even if the other spots of cancer were invisible in the early stages – total breast removal (mastectomy) was recommended even at this every early stage of cancer diagnosis. She eventually had a skin sparing mastectomy (skin is spared although the breast tissue and the nipple was removed) and armpit lymph node sampling, followed by a TRAM flap, that is, the fat and muscle of the abdomen was tunnelled up on a pedicle to create a new breast on the right side. The photographs show the appearance of the reconstructed breast and the progress up to 1 year from the operation. The normal left breast is shown for comparison. Please note that this type of surgical treatment and reconstruction may not be suitable for your type of cancer. The planning is always individualized to the type of breast cancer you have, where it is located, how large it is relative to your breast size, if it has spread to neighbouring structures or spread far away and the need for other treatment such as chemotherapy and radiotherapy. 
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| The cluster of suspicious calcifications on the mammogram – magnified view (the cluster of odd shaped white spots). There is no lump. | Picture of the breasts before surgery. Please note, they appear normal even though there may be mild asymmetry between right and left breasts – this is a normal finding in many people. | 
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| After skin sparing mastectomy and TRAM flap. The right breast has actually been removed, although the only scar one sees is a “patch” over the area of the nipple. The right breast appears larger and is actually swollen from the recent operation. The yellowish discolouration is due to a resolving blue black (from the surgery – bleeding is expected). The nipple has been removed in the skin sparing mastectomy. | The fat comes from the abdominal wall and a large scar is noted in the lower abdomen where the actual surgery to move the fat up to the right breast area was done. This external appearance is similar to that for a tummy tuck for removing excess floppy tummy skin and excess fat! So in the process, the patient gets some fat removed and a tightening of the “sagging” abdomen. | 
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| 8 weeks after surgery. The skin has returned to a normal colour although the margin of the sewn on “patch” is still reddish. | 14 weeks after surgery | 
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| 20 weeks after surgery | 1 year later – the margin of the central patched skin still appears obvious and dark brown/reddish. This is hyperpigmentation of the scar and normally seen in fair people. The breast shape is still slightly larger than the left. Over time, the scar margin will eventually become lighter. |
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