This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question. Question:I am a newly diagnosed cancer patient in Atlanta. I am scheduled for a left side mastectomy a week from today. Mammography and MRI found pretty extensive DCIS on the left side of the left breast extending to and abutting the chest wall. I am likely to require radiation treatment because of the proximity to the chest wall. My plan is to have a tissue expander put in at the time of surgery. I cannot get myself comfortable with the idea of an implant although my plastic surgeon here has said I am too thin for a natural reconstruction procedure. I am interested in revisiting this and/or maybe getting a second opinion after the mastectomy. My question is when the optimal time for a natural reconstruction would be when radiation treatment is planned? Should it be done at the same time as the mastectomy ideally or after radiation treatment? Thank you.Answer: Hi and thanks for your question. Sounds to me like you are on track for doing things the right way. If you need radiation we would not want you to have natural tissue reconstruction until after your radiation treatment. Possibly 3 months after radiation is complete. In the meantime having the expander placed immediately after the mastectomy (same procedure). Then you can remove the expander later at the time of your natural tissue reconstruction. I would be glad to give you my opinion I frequently see patients who other doctors say they don’t have enough tissue. Frequently we can get a nice result with natural tissue. Let me know if you have other questions or would like to talk over the phone. Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!