Stage 0 DCIS Grade is 2-3, ER++ and PR +++

My guess is that an ER+/PR+ grade 2-3 DCIS is probably among the most common diagnoses of DCIS.  It's not the lowest risk - which would be a small ER+/PR+ grade 1 DCIS - but certainly it's not the most aggressive.  So that's good news. 

How large is your area of DCIS?  Single focus or multi-focal? 

And up to this point, have you had just a needle biopsy or have you had a surgical biopsy / lumpectomy?  

Are you having the SNB done only on the DCIS side?  Normally when someone with DCIS has a MX, an SNB is done, however because DCIS cannot move to the nodes, the only risk of finding nodal involvement is if it turns out that some invasive cancer is found in your breast, in addition to the DCIS.  So the odds of both these things happening (finding invasive cancer and being node positive) is very low for those who have a preliminary diagnosis of pure DCIS. 

These days, even when invasive cancer and nodal involvement is found, often an axillary node dissection is not done.  With nodal involvement, chemo is often recommended, and studies have found that for those who have chemo, there is no difference in survival between those who have just an SNB vs. those who have a full axillary dissection.  The more nodes removed, the greater the risk of lymphedema (and this is a life long risk) so as a rule it's better to not remove more nodes than necessary.   Just something to consider before you agree to your surgeon going ahead, during your BMX surgery, with a full axillary dissection, should you be found to be node positive.

Are you having reconstruction?   And if so, are you having immediate reconstruction (i.e. the first phase of reconstruction is started at the time of the MX)?  That will make a big difference in what you can expect from the surgery.

Sorry for all the questions, but what you can expect varies a lot depending on some of these things.

EDITED to add:  Lady_Airsong, I just read your other post, so there is one thing I want to add. While a BMX may reduce your risk of recurrence and will significantly reduce your risk of being diagnosed again, unfortunately some risk will remain.  So you will need to remain diligent and check for lumps, and you may need a biopsy in the future.  Unfortunately there is nothing we can do to ensure that we never have to worry about breast cancer again - even a BMX after a non-invasive diagnosis can't ensure this. 

Of course you are scared!  That's normal.  But the thing to remember is that you have what appears to be a very favorable diagnosis.  

So, a few things:

Normally DCIS does not present as a lump; usually it's discovered through calcifications. So the fact that you had no lump is pretty much the norm for those who have DCIS.

0.4cm is tiny.  Really tiny.  Hopefully the final pathology confirms the small size, but you should be aware that it's possible, after surgery and once you have the final pathology report, that the actual area of DCIS might turn out to be larger - imaging isn't always completely accurate.  But, whatever size your cancer ends up being, it's unlikely to be large.  To put it in perspective, I had over 6cm (actually more like 7 or 8 cm) of high grade DCIS with comedonecrosis, in two different areas of my breast.  

Your DCIS, being intermediate to high grade, and with necrosis, is somewhat aggressive.  That's why if you had a lumpectomy, even though the area of DCIS is so small, radiation would be recommended.  A mastectomy is the way to avoid radiation. 

With no reconstruction, mastectomy surgery generally is pretty easy.  Not having reconstruction makes it a much simpler and quicker surgery and recovery.  Lots of women choose no reconstruction.  This board has a forum specifically for women who choose the no reconstruction option.  You might want to read there, and maybe post your questions there about the surgery and recovery.  I had a single MX with implant reconstruction, with the expander placed at the time of my MX, so my experience was different.  Here's a link to the other forum on this board : Living Without Reconstruction After a Mastectomy

Your surgery order appears to specify only a left breast mastectomy; there is no reference to your right breast.  If that's the complete document, and if you are expecting to have a bilateral mastectomy, you'd better clear that up with your surgeon.  The surgical order does allow the surgeon to proceed with an axillary node dissection if he feels it's necessary.  Personally, if it were me, I would not agree to that.  Nor would I agree to having an SNB done on the prophylactic side.  But there are different points of view about that, and so those are decisions you need to make for yourself.  My recommendation is that you read up more about it, ask more about it on this board, talk to your surgeon and maybe get a second opinion before the surgery date. In the end, it is your decision on what the surgeon is approved to do when he operates.  

Lastly, this post that I wrote some time ago explains more about DCIS: A layperson's guide to DCIS

Hope that helps.

Hi Lady Airsong, I would agree with everything Beesie has told you here and I would urge you to read her info on DCIS. I printed it out for my friends and family when i was Dx.

I am a Uni, just one breast, no recon, there are a lot of us around the boards. I chose to have just the Umx, no Rads, if I didn't have any surprises after the final pathology, fortunately, I didn't and I also had a SNB.

I had a very easy time with my surgery and SNB, a few hiccups along the way, but nothing serious. I am almost 2 years out and haven't regretted any of my decisions. Take care, and come visit the other threads and talk to the other ladies about living without recon. 

Hi LadyAirsong! Glad to hear you're through the surgery and on this side of it now. Congratulations!

Sounds like you have a great final pathology report. By having the Mx and a clear path report, you don't require the rads that you likely would have had, if you had opted for a lumpectomy. Chemo is never given for Pure DCIS and Tam isn't a done deal after this Dx, I don't take it either. You certainly can opt to take Tam, but I would be finding out if the pros outweigh the cons, in your personal situation.

You have the final path that everyone would like to have!

I am a little confused with your surgery line, did you have both, an Axillary clearance and a Sentinel Node Biopsy?

I wish you the very best for a speedy, uneventful recovery!