unilateral of bilateral mastectomy for DCIS?

Jelson, I'll see MO and RO this week. I 'm  also seeking a consult at UCSF with Dr. Esserman, who will not see me but transfer to one  of her associates. My problem is a reflection of modern medicine: they do not treat a patient as a whole but concentrate on separate issues. The first lumpectomy was done in a hope that DCIS is just 3 cm - 5.5X5 cm piece with additional margins  removed. The second  one - 3.5X4.5 cm +  margins, it had  more DCIS, which was not detectable on high-resolution mammogram. I understand that the surgeon goes in blindly, and has to guess. I also understand that doctors must be detached to do their job,  but I's me - a living human being who is a subject of their procedures, and it cases suffering to me. I'm seeking your advice on how to approach the whole situation, because you  have been there, and understand the emotional and physical toll of medical treatment. I can approach it rationally, but my heart cannot accept certain rational decisions. I'm a scientist, but I fully understand the limitations of a scientific method. Medicine is hardly a science: it's impossible to build a scientific  model of a phenomenon, design and carry out an experiment, and prove or disprove this model based on experimental evidence. Medicine is about what works, and what does not. Unfortunately, what works for one ,does not work for another individual. It would be so nice to have some intuition and faith, and not  make decisions based on fear. I'm seeking your advice on decision-making. Thank you

Thank you for everyone's compassion and support. I'm trying  to be somewhat detached, and rationally approach   my case, but my heart is in fear, and it clouds my judgement. And I do have questions.

Did your surgeon offer SNB for the suspicious breast? How did you make a decision not to do SNB on it? What if the suspicious stuff turns malignant after  BMX?

Also, how would I know if cancer returns to my flat chest?

 I will not do reconstruction to avoid more surgeries.

My DH is the one who pushes for cutting off piece by piece, when the pieces become malignant. I cannot convince him that each procedure causes physical and emotional turmoil.  

I'm worried about lymphedema and PMPS, and the havoc  antibiotics will certainly do to my GI. It took me three years to nurse my intestines to some resemblance of normalcy after h. pylori treatment. I'm taking  probiotics for three years now with limited success.

My DH, although highly educated, is mildly in denial. His philosophy is to cut only what's necessary. I made a  clear point to my surgeon  that I do not want  rads from the start, but was hoping that DCIS was highly localized. I could not mentally accept a mastectomy from the beginning. The extend of the problem was not known to me. I was lead to believe that grading of dcis is  subjective, and there are instances when rads can be omitted. Only after researching high-grade dcis and realizing the seriousness of it, I started thinking about a mastectomy. My surgeon also gives me "low %"  talk on lymphedema.  I want to have at least one good side. I doubt I'll have any support on BMX from the surgeon. He did the oncoplasty with each lumpectomy - could not help himself. Now I have a dog ear in between my breasts where there was some fat,  and look like a hooker from Total Recall.   Looking back at my posts, I would advice myself to find another surgeon, but mine is the best in town who does bc surgeries. I also may have an option to go to UC Davis, but it is a teaching hospital, and they let students practice cutting  you. I have an acquaintance   that had meshes put in for his hernia, ended up with a big bruise extending from his knees to the neck, got hooked on pain meds, an eventually fired from his job.

The truth is - no surgeon is perfect, but teaching hospitals allow students to practice procedures on patients. This is not acceptable for me. I need surgeon to do his job after I make up my mind what to do. They are humans that have their own philosophy and outlook on life , and they live by it. Any surgery can turn out badly, even in the hands of a good surgeon.   I'm very much aware of possible bad outcomes.  I'm scared to death already. I have the insurance that I have. I cannot go to Pink Lotus clinic, or have surgery at UCSF by Dr. Esserman, or by Dr. Silverstein. I've seen another surgeon  covered by my insurance regarding my other surgical issue, and I wasn't impressed: he just said that I have to decide if I want to do a procedure, or just stop bothering him. He also came very much recommended. Surgeons perform procedures to the best of their ability and to the best of their judgement. Like all of us they make mistakes and have bad days. Their job is to make life and death decisions every day. No human being can handle such stress. They  also have to stay detached  from our personalities in order to do their job. We as patients pay for their mistakes, but that's what we have to accept when we  seek their help. They are not Gods.

I  got my pathology report later today:  nodes are clean, some DCIS around the lumpectomy site, no IDC found in either breast, seemingly clean margins. This is the best I could hope for. My husband  thinks that I needlessly cut out the breasts, but I'm happy if I can  avoid rads and hormonals. I didn't do well on the pill - was rendered non-functional, foggy minded,  with restless leg syndrome after only 4 days on estrogen. I realize that tamoxifen and AIs can be different, but still... Well, I hope I bought myself some time, but I fully realize that the ugly recurrence  beast can raise it's head any time, and BMX is not a cure but a chance .

Thank you again for sharing your experience and expertise, for being there for me, for your help and understanding. I'll strive to pay it forward.