Breast Cancer Surgery

I am a 48 year old female, recently diagnosed with invasive ductal, 1.8 CM tumor in right breast.  I am consideing a lumpectomy w/ radiation or single mastectomy (hopefully using my own tissue or bi-lateral (hopefully using my own tissue).  I do not have enough abdomen tissue for both breasts.  I live in South Florida, and am consulting with physicians at the University of Miami (Sylvester Cancer Institute). I do have a history of breast cancer on both sides of my family.  My first genetic test came back with an "uncertain significance" on BRCA1.  Then, I had a BART test which was negative. I am strongly considering a bi-lateral and Sylvester is starting a clinical trial using your own nipple and areola with mastectomy, then radiation of just the nipple and areola afterwards.  

Here are my questions:

1. The surgeries using your own tissue are more complex, take more time, and have more risk (since they have to use your blood vessels, etc.).  Is this worth it or should I go the conventional route (bi-lateral with implants....and if so, which is better saline or silicone?).  

2. I am fearful about a lumpectomy with radiation (I am not sure I would feel comfortable to due to the possible impact of radiation). And, depending on how much tissue they have to take, it may leave my breast with a large indention (i understand there is no "filler" they can use for lumpectomies). It is very difficult to get pictures of anything to see potential results due to HIPPA.  Does anyone know of any websites that show pictures after lumpectomy, radiation and mastectomies (using your own tissue or using implants) that are reputable?

3. What is your opinion about clinical trials (obviously no historical data) but it doesn't seem to be that complex (using your own nipple and areola).

[japdip]

First I would suggest that you post on the "Reconstructive Surgery" section of the Expert Forums. A Plastic Surgeon answers questions there. He would be more qualified to answer your concerns than anyone here. Personally I would want to know if there were any lymph node involvement before I decided which way to go. If involvement is present then mastectomy would be followed by additional treatment. As far as the trial .... why not ?? All reconstructive surgery is complicated to some degree. You might also get a second opinion from another Plastic Surgeon in your area. Often this can help clarify the situation. Bilat. is such a personal choice I would hesitate to even offer an opinion about that. I thought I saw a site a couple of years ago that had photos of verious breast surgeries and reconstructions ... I'm sorry I don't recall the name of it .... I must have put it in "search" though. You might try that and see where it takes you. One thing I will caution you about though; I recall that a great deal of the photos left a lot to be desired as far as cosmetic appearance is concerned. I still think a second Plastic Surgeon would be your best source of information. Regards ...