bad margins, new decisions to make

Boy, does your situation sound familiar.  I had an excisional biopsy - same surgery as a lumpectomy except that I hadn't been diagnosed yet - for 2 known areas of calcifications. What came back was that I had DCIS in both those areas, and all the margins were dirty.  Plus I had the little surprise of having a microinvasion too.  So like you, I was headed to a mastectomy.

What your surgeon said about the other breast is absolutely true.  It is completely separate and DCIS cannot travel from one breast to the other.  But that doesn't mean that you may not have other unrelated problems with that breast and this is something you should investigate thoroughly before you make this decision.  This is particularly important since you are choosing a reconstruction method that can only be done one time.  In my case, I was having implant reconstruction (so I can't help with the DIEP vs. TRAM decision), however my surgeon still insisted that I have an MRI prior to surgery.  His explanation was that he wanted to have the best idea possible of what was going on inside my breast before he operated.  And he also wanted to be as sure as possible that my other breast was okay because if something showed up, we might as well deal with it all at once.  My MRI showed that my breast with DCIS was in fact full of breast cancer, so that confirmed the mastectomy decision, while my other breast showed up perfectly clear on the MRI (despite a number of previous biopsies).  So that really helped me be comfortable with the decision to have a single mastectomy.  

My suggestion is that if you have not had an MRI, insist on having one prior to surgery.  It can really help with your decision on a single vs. bilateral.  I know it did for me, and I know that it has for many other women who've come through this board.

Good luck!

One more voice saying it's true that you only get one shot at using your abdominal area.  That was one of my concerns when thinking about a unilateral mastectomy.

In the end I didn't have a mastectomy at all, but for a long while I thought I would and went through the planning/decisionmaking process.

Implants would have looked really silly on my body with one large saggy breast and one smaller perky one, so I really wanted to do a tissue transfer recon; but I was very concerned about only having one shot at it (I just had a 'gut feeling' about that) and I was also desperately trying to find a way out of having a mastectomy at all - which, due to my particular presentation, I was finally able to do.

I'd recommend a MRI to try and make sure there really IS nothing currently going on in your "healthy" breast. 

Also, bear in mind, as I was told, if you ever needed another mastectomy, you could always do a lat flap or S-GAP or something, there are other donor sites.  Are you comfortable with that?

In my case, I ended up having surgery on both breasts - and found that there was residual LCIS in the "bad boob" plus ADH (or ALH) in BOTH breasts, even the "healthy" one.  So, although I'm planning on rads and Tamoxifen, I kind of think I'm a recurrence waiting to happen. 

If I do end up with DCIS (or worse) again, I'll do the flap surgery then.  And, for me, I'm glad I've preserved the option.

But if I'd had no choice other than mastectomy, I'd probably have done DIEP and then another donor site later, if it came to that.  I was all about preserving what I could as long as I could.

Best wishes on your decisionmaking, it's awfully hard.

I am 4 yrs. post mastectomy and immediate reconstruction/ free tram flap.  I too considered DIEP vs. free tram, but my PS, a world renowned physician in Cleveland, Oh, recommended against the DIEP.  The free tram is amazing.  Looks very natural and the tummy tuck was like "making lemonaide out of lemons"!!  If I should need a second reconstruction (God forbid please!!) she said she could access other body areas to harvest fat!!  Recovery was bearable!!  I rested for about 2 weeks and gradually returned to all activities with three months.  Best decision I ever made!!  PS also advised against implants!!  Much of her surgery is removing them after failures and dissatisfaction!!  Beware!!