DCIS - Unilateral MX and reconstruction

40wDCISnowIDC

I have read a lot on here about the choice to go bilateral with DCIS but not as much about pros and cons of staying with unilateral. I am planning for reconstruction on the right for DCIS.  On my right, I had a papilloma removed by excision which was confirmed benign.  Now I have to decide UMX or BMX.  I am leaning toward a flap reconstruction either way. Very confused about what the deal is with staying unilateral. 

gardengumby

I had DCIS and IDC in my left breast plus a papilloma in my right.  I chose UMX with a DIEP flap reconstruction.  It's all just personal choice.  Some people want to do as little as possible others want to feel more assured that they have done everything possible to reduce the chance of needing to go through it again.  I'm glad I made the choices I made - though a DIEP is anything but "as little as possible"...  I'm certain that if I should have a recurrence in my right breast I'll be heavily PO'd that I didn't opt for a BMX, but for now (2+ years out) I'm still OK and still glad I chose UMX.

mrenee68

It is just personal choice and what you feel comfortable with. I really didn't want to remove one breast so the idea of removing a "healthy" breast was out of the question. I know that I will need extra screening and that will bring on some stress but I will deal with it. At least for now I have a really breast with real feeling. If need be I can remove it. Remember once it's gone you can't get it back. Good luck!

Beesie

If you have breast cancer (DCIS or invasive) in only one breast, all you need medically is surgery on that one breast.  So if you either require (due to the size of the area of cancer) or choose to have a mastectomy, a UMX is all that is medically necessary.

If someone is very high risk to be diagnosed again, either because they are BRCA positive or have a strong family history, or perhaps because a high risk condition such as ADH or LCIS has already been found in the other breast, then there can be a medical argument for having a BMX instead of a UMX. Even in this situation, having a UMX remains a perfectly reasonable choice.  For those who are not high risk to be diagnosed again, a BMX is a choice made for non-medical reasons, whether it be peace of mind, fear of another diagnosis, a desire to be even on both sides (although with reconstruction that's certainly not guaranteed even if you have a BMX), etc.. 

I had a UMX. I'd had several benign biopsies of my 'good' breast over the years, and I do have extremely dense breast tissue, but when my pre-surgery MRI showed my 'good' breast to be perfectly clear, I simply could not justify removal of a healthy body part. I also was concerned that a MX and reconstruction can have side effects (certainly loss of breast and nipple sensation and also the risk of pain, scarring, the need for more surgeries, etc.) and I didn't want to double my risk of problems by having both sides done.  That was 7 years ago and so far, so good.  I've had a couple of 6 month follow-ups on the remaining breast because of complex cysts, but nothing more serious than that.  I'm very happy with my choice. 

It is a very personal choice. Only you can know what's best for you to do. Some time ago I put together a list of considerations for those making the decison between a lumpectomy, MX and BMX.  Here's a link to an earlier discussion thread where I posted this list:  Topic: Bilateral Mastectomy Decision  Look for my 2nd December 7th post on the first page of this thread.  You might find it helpful.

Good luck with your decision!