Recurrence 18 years after breast cancer

Well, it looks like the beast is back. In 1998 I had breast cancer with a lumpectomy, chemo and radiation. Five years later, I was found to have two additional primary cancers - uterine and fallopian cancers. I had hysterectomy followed by chemo - bald again - smile... Now 13 years after my last experience with cancer, my CA 15.3 tumor marker tests were elevated so my new oncology doc ordered MRI and PET scans - both showed a mass in same breast and near same area as first cancer. I tried to have an ultrasound guided biopsy but they were not able to see the spot with the ultrasound - it is below my surgical scarring from years ago. My oncologist has now ordered an MRI guided biopsy. I do not know how that will work as my recent MRI had me face down with my breasts falling out the bottom of the table... weird, huh? He further said that even a negative biopsy is not a clear indicator that there is no cancer as it may be hard to pinpoint the exact area and that a mastectomy would be the next step. I think I just want to go ahead with the mastectomy and get it over with though I suppose they may be able to get good diagnostic info from the biopsy - if they wind up with actual cancer cells.

The next thing is: Do I want to go ahead and get a full double mastectomy? Maybe... And: Do I want to consider reconstructive surgery either at the time of the initial mastectomy or later. I am 63 years old with a partner of 24+ years. My breasts were always important to me in the way that only a woman with a truly spectacular set can be - just joking but I have been a 46 G for years. My lumpectomy left me with a left breast that is half the size of my right but still a large DD size. My point is, I have adjusted to that with relatively few hiccups so should I just accept the new chest minus one or two breasts or should I go ahead with reconstruction? Another factor is that I am a type 2 diabetic who has a hard time fighting off any infection. I had almost two years of infection after my lumpectomy. I am leaning towards a left side mastectomy and just leave the right side alone and keep checking it like I have been doing for 18 years.

I am pretty comfortable with the fact of mortality. At 63, I fully understand that at some point I will die. What I will die of is the question. I want life so much that I am ready to have more chemo - bald for the third time... Is the less worry a palliative right mastectomy will provide worth the risk of more infections - to say nothing of the pain of surgery and recovery. I also do not heal well because of my diabetes...

I have a lot to think about. To further complicate things, my oncologist is new due to my previous oncologist moving to another hospital. I know yaw'll can understand what I am going through. I must say I am a bit more cranky than I was in 1998 - but aren't we all? Any feedback will be appreciated. There are probably many ways to look at this I have not considered. Your insights may be a huge help. Thanks for "listening".