A: I am afraid that I can't comment on your individual case. Only your own doctors know all the ins and outs of it. However, the advice you have had would be very similar to that I would offer any patient of mine who had had apparently similar problems to your own. From what you say it seems first class, cautious and wise.

It is an excellent idea to have a plastic surgeon review a case before surgery. The question of reconstruction is a matter of the patient's philosophy as well as of medical practice. When all the circumstances have been explained to a patient she has to make the decision whether to have plastic surgery and a reconstruction or to use a prosthesis. Plastic surgery for breast reconstruction has improved out of all recognition over the last ten years.

Q4: When I was diagnosed nearly five years ago, the NHS at the Marsden hospital said the wait for surgery was six weeks so rather than risk a mastectomy I went private and in 48 hours I had a lumpectomy. My drugs, the arumidex combined with the fosamex, is fine except for some stiffness and hot flashes (I already went through this 12 years ago). But no one tells you this. Please remind people to have a bone density test because this is something which no doctor offers - the patient has to ask and insist.

I did a lot of research and during my radiation, I took the decision to drink aloe vera juice mixed with freshly made juice at home as the taste is ghastly. I also put aloe vera gel mixed with plain oil on my chest four times a day. I believe this was why my skin was in perfect condition after the treatment with no rashes or burns. Doctors do not suggest such treatment because there no kickbacks to them from natural products.

I also think that having physiotherapy after surgery was a brillant move, and psychological counselling as ones partner is not always supportive. What is magical about taking the above drugs for five years? Keep writing and opening up this all important subject. Susan Mocatta, West London.

A: This is another case I can't comment on individually. However I can say that even fifty years ago when I started in medicine and doctors still thought it important to preserve a mystique, an aura of great learning, I believed that I was appropriate to have books on pharmacology and pharmaceutical preparations on my desk beside me. My style appalled my early senior partners but I invariably looked up the drugs I was prescribing with the patient present and we discussed the side effects together.

Osteoporosis is still grossly under-diagnosed and even when diagnosed under-treated. There is an absurd edict that basically suggests that a patient has to wait until their bones are beginning to crumble before they can have the appropriate treatment to strengthen them.

Before medicine was dominated by the bottom line, the cost it will pose to the Treasury, the principle always was that it was the doctor's role to prevent trouble occurring and not to rely on treating it once it had happened.

The amount of burning from irradiation of the breast is much less now that it can be more accurately directed and is computer controlled. Even so, the healthier the skin the less likely there is to be trouble.

Partners should always be included in any psychological counselling should the patient wish this, and that has to be her decision. Physiotherapy certainly helps a patient's morale. The length of time that drugs are taken is very variable and has been subject to many long trials and the outcome of these are usually used to determine the length of time the treatment will continue. Surprisingly, patients don't always do better by taking some drugs for longer than a specific time. Discuss this with your doctor and he will explain what drugs you are having and why a particular time limit has been set.

Q5: If a lump has to be removed (whether is benign or malignant) will it damage or change the shape of the breast at all? Name and address withheld.

A: It depends how big the lump is and how much surrounding tissue has been removed. Hence my plea for more frequent resort to frozen sections of the lump at the time of the surgery. It is amazing how breasts do recover but no one could be certain what the long term effect would be of a lumpectomy on the appearance of a woman's breast. What is more encouraging is that although any damage to a breast often strikes at the heart of a woman's feeling of femininity and undermines her self-confidence it doesn't usually make the same impact on her male partner. Research done fifteen or twenty ago, but I don't suppose the results would be different now, showed that breast surgery only rarely made any difference to how a woman's partner viewed her sexual allure.