Unilateral or Bilateral mastectomy?

I had a unilateral for IDC. They found DCIS in there, too, during the mx. For a week or two I regretted not having a bilateral. My oncologist, breast surgeon and radiology oncologist all said the incidence of getting BC in the other natural breast was low, even if there might be DCIS hiding in there. In general, they don’t want to do a somewhat extreme surgery that you don’t need for a hypothetical situation, unless there’s something genetic going on.

Like Beesie said, you lose feeling with mx. My breasts will not be symmetrical when I’m done with reconstruction, but my mx breast was always bigger anyways. I thought symmetrical, firm, high breasts would be the most important aesthetic outcome for me, but having one natural breast for feeling seems to be just as important right now.

As others have mentioned, it is a personal decision. One other factor to consider is the type of reconstruction you will end up getting. If you plan to do a DIEP Flap, you only really get one shot. If you are only reconstructing one breast, the remainder of the DIEP flap is tossed. I had DCIS 10 years ago. Mine was small enough that they treated it with lumpectomy and radiation. However, it took several surgeries to get clear margins. I contemplated UMX and BMX at that time, but I stuck with the lumpectomies and radiation. Now, 10 years later I have IDC in the same spot as my DCIS, at age 50. The docs are throwing the book at me and giving me ACT chemo (I have completed 3 of 16 rounds so far) before surgery to shrink the tumor, followed by DMX, proton therapy radiation (yes, radiation again), and hormonal therapy. I plan to do DIEP flap reconstruction. If I could go back in time, I would have opted for the DMX, even though it is no guarantee that the cancer would not come back in the chest wall or elsewhere. Seek input, weigh your options, get a second opinion, and go with what feels right for you. Best of luck to you!

I don't know if this helps, but I had two mastectomies, separately. My doc wanted to see how I handled the first one before doing the next (I have other health concerns). You could do one and then decide after that first surgery about the second.

The emphasis on symmetry may be because legally, regarding insurance coverage of a BMX or second mastectomy, you are entitled to "symmetry."

I had pain in my non-cancer breast. Turns out it was full of cysts but also some precancerous areas so I was glad I had it done!

Windingshores- I was so excited to see your suggestion of doing one at a time, as that is exactly what I will be doing this Thursday. I have IDC and extensive DCIS in my right breast- lumpectomy was not recommended, but my left breast is clear on all scans- including MRI with contrast- so I have opted to have a unilateral mastectomy on my diseased side, then see how I tolerate it and how things go. My oncologist and both oncological breast surgeons I consulted all said that, in my case (which is definitely the most important thing for anyone to consider), my overall survival would not be affected by doing BMX over UMX. For me, it came down to exactly what you said: wanting to see how I handled it first (I, too, have other health issues related to high blood pressure and history of stroke when I was 36- I’m 50 now- and appreciate the option).
I know there are pros and cons to doing just one surgery, but did you find that your recovery seemed a bit easier because you were able to use your other side to assist with various tasks? And how long did you wait between the two?

All-Did any of you who opted for UMX feel like you got a lot of the “are you crazy” looks when people found out your decision was not to do BMX immediately or maybe not at all? I have finally gotten my rationale down to an “elevator speech” length, but geez. Most people just don’t seem to have any concept of how breast cancers manifest and that we all have different factors that drive our decisions on treatment- I was clueless before my own diagnosis, so I completely understand where they’re coming from. As a former high school English teacher, I can’t help myself but to try to educate them a bit on the one-size-doesn’t-fit-all aspect of our treatment options without sounding like the Pedantic Pink Princess of Puketober. 😉