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In contrast to the 17% local failure rate quoted above, a surgical paper claimed a 1% local recurrence rate for DCIS treated by mastectomy. The authors, from the Breast Center in Van Nuys, California, used what was termed glandular replacement therapy. This involved a combination of skin-sparing mastectomy and autologous tissue reconstruction (generally with a free transverse rectus abdominis flap). A circumareolar incision with a linear extension was used, so that the skin envelope remained intact allowing autologous tissue reconstruction with the new breast of almost the same size, shape, and texture as the breast that has been removed. The circular defect left by excision of the nipple-areolar complex is filled with skin transferred on the flap. Initially, this skin is used to monitor the flap, and later to reconstruct the nipple-areolar complex. Initially, the procedure costs more than radiotherapy. The authors point out that this is a one-time cost, whereas conservative treatment requires life-long mammography, about 40% can expect additional biopsies at some time in the future, somewhere in the region of 20% will experience a local recurrence. Since half of all local recurrences are invasive, there may be a mortality rate of 2-4% for DCIS patients treated conservatively.