Sarah Smith is 36 years old woman with one daughter and lives with her husband. She was diagnosed with high grade Ductus Carcinoma In Situ (DCIS) with metastasis disease noted in her axillary nodes and at the time she requested a pregnancy test which was positive. Unfortunately, her pregnancy was in an ectopic position and so she underwent surgery to terminate the pregnancy. This really was an emotional nightmare for both Sarah and her husband. As for the staging of her breast carcinoma she was on stage 3A -Tumour In Situ- 2, Lymph node metastases fixed palpable node-2 with M0 no distant metastases .Her case was discussed in the Multi-Disciplinary meeting and it was concluded that she will require mastectomy and axillary node clearance. She was given a choice for immediate or delay breast reconstruction. She has chosen immediate breast reconstruction for the Psychological reason. She had Mastectomy with immediate reconstruction with Implant Latissimus Dorsi flap. this is my case study which i choosen.