newbie with questions

I wish I could offer any advice; I'm in a very similar situation! ("half-breast-ectomy" -- love that! that's pretty much what mine was!) 

My half-breast-ectomy didn't have clear margins either, but my surgeon is saying that re-excision is the next step... he hasn't even suggested a mastectomy. I wonder why the very different recommendations for such similar situations? Mine was all grade 2; maybe that's why??

Anyway, good suggestion from Aloha re: genetic testing... they are recommending that for me as well. (I don't think that's it, in my case, though, because all the women in my family live to ripe old ages, even my chain smoking grandmother lived to her late 80's and never got cancer! But, it's a simple blood test so I figure why not leave any stone unturned.)

Intermediate nuclear grade is also known as grade 2, high nuclear grade as grade 3.

I'm 52, premenopausal, etc - also with a skimpy family history and was trying to decide about bilateral.  I asked for the BRCA test and my ins co balked at first, asking for a letter of medical necessity.  The genetic counselor wrote one, and it was covered.  Luckily, I was negative.  Everyone expected it to be negative, but after coming up on the wrong side of the odds so many times recently....I wasn't so sure.  But YAY, I finally got some good news!  I'm only thinking about a uni now.  A bilateral is more than I can possibly wrap my mind around right now.

For multicentric (disease in different quadrants of the breast), mastectomy is standard treatment, though some Drs are willing to try lumpectomies anyway.

For multifocal (disease in more than one spot in the same quadrant of the breast) more Drs are willing to try lumpectomies.  I suppose the main distinction is how far apart the areas are.  If they're reasonably close, more chance for successful lumpectomy.

Or so I believe, at this point in my journey.

Oh, forgot - it may be different at different hospitals, but the oncologist doesn't necessarily do the genetic test, a genetic counselor working with a genetics MD does.  Your surgeon should be able to refer you, you probably don't need to see an oncologist first.  Normally, patients don't see an oncologist until after surgery - though you could probably arrange it if you really want to. 

I had lumpectomy 4/17/09 and 3 of 4 margins were DCIS right side only.  I had MRI that did not show anything else.  I made choice to have bital Mx 5/1 with no reconstruction. The path report after Mx showed multifocal areas elsewhere. I was told if did not have Mx give my age(46) I had 30% of recurrence and with Mx had 1%.  That did it for me. I have no regrets about my choice. If you have questions you can post or PM and I will be glad to answer.  Hang in there...FIGHT

Assuming your insurance will cover it, I'd say you should talk to another oncologist b/c you don't seem comfortable with the one you've seen.  My GYN doesn't think I have real cancer either.  I still love him, but then, I'm not using him as a cancer Dr,

You don't need an onclogist for the genetic test anyway (at least that's not how it's done where I live), you need a genetic counselor.  If the oncologist won't give you the referral, maybe your surgeon or gyn or PCP or someone else will. 

That said, there are reasons I could accept for an oncologist thinking a genetic test wasn't necessary....but DCIS not being real cancer ISN'T ONE OF THEM.  If that's his/her reason for  advising against the test, I think this onco's a jerk.  Fire him/her!  (IMHO)

Depending on how old you are, the test may be more or less important (more important if you're younger), and I'm not sure really how predictive it is of cancer in the other breast - it might be more of a predictor for ovarian cancer. 

Still, reasons to speak to someone else about it who's more willing to have an open and informed discussion than your onc was.

having had a large area of dcis taken out by the original surgeon, my left breast looks very odd- i weighed my choices, spoke with my onco and decided on a bilat mx (reading your description, it sounds so similar) I also had unclean margins and my other choice was re excision and reconstruction plus rads and preferably tamox...

Initally i thought id be okay without reconstruction, but looking at the 'pit' left in my breast next to the excision scar bothers me...im always looking at it, everytime i see it, I wonder about getting cancer again. Ive always had rather large boobs, if anything perhaps id be relieved to have them 'gone'. but i guess id like to be able to look in the mirror and not think of breast cancer coming back..hard to say sometimes. I know i made the right choice for me...everyone's different.

Someone else suggested the BRCA test (which i did, it was negative) 

 do whats right for you - and having an onco you can trust is the key..

tender

Of course women under 50 should get mammograms and i think the public outcry is going to loud enough to make sure it stays that way.  as for your situation..They may not tell you(no one told me when I had MRi on a Sat too) but the contrast dye can give you a wicked headache about 30minutes or so after. I had MRI ad went shopping. I was standing in the middle of a store, room started spinning, i got  dizzy and then felt like my head was going to blow off shoulders.  It may not hit you that way, but just plan on not doing too much after it.  I also tripled up on water, juice, etc to get it out of my body.

You will have to get all the information you can and then make a decision that is right for you. Breathe...There are some many wonderful women here who have all been where you are now. I can only share my choice. After lumpectomy I had 3/4 margins still DCIS. I had MRI that did not show any other places of concern.  I decided to have bilat mx.  The path report on the right breast camae back and found other areas of DCIS that had not been on mammogram or MRI.  So I know for me the decision was the right one.  My left breast was clear but I still do not regret my choice. 

What you face is doable   You can come up with the right plan for you and fight your way to the otherside. If you have direct questions, feel free to ask them here or PM me.  I am willing to share all I can. Knowledge is power.