I cannot emphasize enough, the best breast reconstructions are not just dependent on the plastic surgeon, you need a GREAT general surgeon or surgical oncologist. These are the types of surgeons that resect the breast tissue, and if they screw up or make bad choices, you are living with that, forever, mo matter how fabulous your plastic surgeon. First, you need the best incision. Only remove the nipple if you ABSOLUTELY have to. It;s well studied now that nipples can be left alone and there is no change in the cure rate, unless of course the tumor is actually in the nipple or right next to it. The best incision is under the breast, in my very opinionated opinion, because those side slashes look bad. Finally, ask the breast surgeon what their rate of mastectomy flap necrosis is. You may be shocked to hear that the average is 15%, and I have worked in the past with surgeons where it is as high as 40-50%. Horrible!! We are talking skin dying and turning blue and black and need to be cut off or getting infected. I've got to give a shout out to my friends at Bedford Breast Center in Beverly Hills whose doctors both have mastectomy flap necrosis rates of less than 1%. The closest you can get to real is to make great choices before the surgery.