Can you tell us a little bit about the surgery how its performed how long it takes its so there’s different types of mastectomies there is a traditional what we call a modified radical mastectomy which is removing the breast and the skin and the and the chest remains flat and then there’s the evolution of that to a skin sparing mastectomy where we remove the nipple and the areola and then remove the breast tissue from under the skin but we retain the skin as much as possible what we call the skin envelope and then the plastic surgeon then fills that space with the reconstruction and then there’s also the nipple sparing mastectomy where we preserve the entire breast including the nipple removing the breast tissue from underneath the skin and then reconstructing that to make it look as close to the original as possible right so dr. Arroyo really depends on how much needs to be taken out and once you once you get in there it it’s you make that decision of what type of mastectomy is gonna happen or well the lot of them the majority of time it what dictates the type of mastectomy is the cancer itself our first and foremost concern is making sure that we do the the appropriate cancer operation and although a cosmetic result is very desirable it is the secondary concern and our challenge is to try and and and marry those to give the patient the adequate surgery while preserving the cosmetic appearance as much as possible so it’s really the location of the cancer the type of the cancer that dictates and also the shape of the breast that dictates what kind of mastectomy is its best suited for the patient you