MX vs BMX

This is a very personal decision, and a decision only you can make.

Because you have DCIS, some of the implications of having a BMX are different from what they would be for someone who has invasive cancer. Therefore I'd suggest you take a read through my post on the first page of the following thread that's pinned near the top of the DCIS forum:

Topic: lumpectomy vs mastectomy - why did you choose your route? https://community.breastcancer.org/forum/68/topics...

Although the thread is specific to the lumpectomy vs. mastectomy decision, the list of considerations I put together apply to the MX vs. BMX decision too. Hopefully this list of considerations helps you determine which path is right for you.

Sounds like a good plan!

As for Tamoxifen...Because you have DCIS and are having a MX, your risk of a localized (in the breast area) recurrence will only be about 1% - 2%, provided that you have clear surgical margins. And if your final pathology remains pure DCIS, your risk of distance recurrence will be practically zero. Therefore, when it comes to your current diagnosis, there is actually no reason to take Tamoxifen; in fact the risks you would expose yourself to from the drug itself might be greater than any small benefit you would get in terms of a recurrence risk reduction.

The reason why Tamoxifen is sometimes recommended after a UMX for DCIS is as a protection for the remaining breast. This is similar to any woman who chooses to take Tamoxifen because she is high risk. Therefore because the Tamoxifen is not required as a treatment for your current diagnosis, you can actually choose to start it at any time. (This would be different for someone who has invasive cancer, and who is taking Tamoxifen to reduce the risk of metastasis that could result from her current diagnosis.)

As an example, in my case, I had a UMX for a very large and very aggressive DCIS, plus I had a microinvasion of IDC (which gives me a small risk of mets, different from those who have pure DCIS). My oncologist actually recommended against Tamoxifen for me, both because my diagnosis (after a UMX) had such a low risk of recurrence and because the risk of cancer in my contralateral breast over the next few years (while I would be taking Tamoxifen and benefiting from the risk reduction) was not high enough to warrant the drug. I did my own research after our discussion and came to the same conclusion. My oncologist said that I might want to revisit the decision in a number of years, simply because breast cancer risk increases as we get older. I'm now 11 years out, so if I had started on Tamoxifen at the time of my diagnosis, I would be off it by now. Hindsight being 20/20, since I haven't been diagnosed with either a recurrence or a new primary cancer during these years, it's clear that I didn't need the Tamoxifen. Of course, many women who have a UMX for DCIS do take Tamoxifen. I would say from my years on this board that about 50% of women who have a UMX for DCIS choose to take Tamoxifen, while the other 50% opt out. All that to say that it's your choice, and it's your decision as to when you choose to start. And this is quite different from the situation for those who have invasive cancer.

Wendy, some women prefer to remove both breasts at once; other women prefer to remove just their cancer breast first, and have the second surgery later. There is no right or wrong answer; the deciding factor is what's right for you.

In your case, from reading your post, I think you've already answered your own question. You said "I don't want to take the risk of wait or postpone my original surgery" and "I do need more time to think about the prevention MX for my right" - both are good reasons to start with the UMX and then move on from there. The one piece of advice I will give is to not have a prophylactic MX unless you are sure you want it and are ready for it, because once it's done, it's done, and there is no going back. It's a big surgery with big implications that changes your body for the rest of your life, so it's not something you want to do if you are unsure.

How long till the second surgery? I don't know the minimum amount of time, given that you do need to recover from the first surgery. Your surgeon can advise you on that, and other women here might have a better idea about that. The maximum amount of time is as long as you want; some women remove their second breast within a short time after their first surgery, but I've seen other women make the decision to do it years later. And some women decide, after a time, to not do it at all.

One consideration is whether you will choose to take Tamoxifen after a UMX, and if so, how well you tolerate it. If you do decide you want to take Tamox as preventative protection for your remaining breast, you can do this for any length of time up until the surgery (at which point you can stop taking it). If you tolerate it well (i.e. don't have too many difficult side effects), then you can continue for as long as you'd like. But if you have problems with it, that might lead you to decide to have the surgery sooner rather than later (or you might at that point feel comfortable with a UMX and no Tamox, as per what I mentioned in my previous post).