No, I have not but would be very interested in finding out if he just based it on the no node involvement and the mastectomies or if there was more.  Did you do chemo?

With a really small tumor and no nodes involved that is a decision one could reasonably make.  There is a website nccn.org that has a patient section giving you decision tree info--look under the patient info section then breast cancer and then your stage--there is another section on other treatment after surgery and there is some explanation there.

Whether or not hormone therapy makes sense after a bilateral mastectomy all depends on your pathology and your recurrence risk. 

After a mastectomy, in most cases the risk of local recurrence is very low - around 1% - 2%.  A drug such as Tamoxifen can reduce this risk by about 40%, which is less than a 1% benefit, far less than the risk you'd expose yourself to by taking Tamoxifen.  The bigger factor in the decision is one's risk of distant recurrence.   

For someone who has lymph node invasion, even though all the breast tissue has been removed with the bilateral, it's known that cancer cells had already moved out of the breast, so the risk of distant recurrence may be quite high.  In this case, Tamoxifen (or an AI for someone who is post-menopausal) will usually be prescribed, if the cancer was ER+.

For someone who has a larger invasive tumor, particularly one that was Grade 3, even if there was no lymph node invasion, there is always the risk that some cancer cells may have escaped the breast prior to the mastectomy.  The risk of distant recurrence is lower than for someone who had lymph node invasion, but there is still risk, so often Tamoxifen or an AI will still be recommended.  

For someone who has a small, non-aggressive invasive tumor (your situation, I think), or for someone who has DCIS, their risk of distant recurrence is very low.  In this case, while some doctors still prescribe Tamoxifen as a precaution, if you look at the numbers, the risk you'd expose yourself to by taking Tamoxifen likely outweighs the benefits.  For example, one's risk of distant recurrence after DCIS is only about 1%.  After a low grade IDC tumor, it may only be 2% - 3% (this is a number you need to get from your oncologist specific to your pathology). This means that the 40% risk reduction you'll get from Tamoxifen is at most 1.2%.  On the other hand, the risk of serious side effects from Tamoxifen is in the range of 2% - 3% (although this varies by individual depending on their own health history). 

So, if you have a very small sized tumor, then your risk of recurrence is likely very low whereas the risk of serious side effects from taking Tamoxifen might be higher.  Based on this, your surgeon's recommendation is not an unusual or out-of-line.  Having said that, I'd recommend that you talk to an oncologist.  An oncologist is the expert on recurrence risk and he/she is in a better position to advise you about your risk level and whether hormone therapy drugs would make sense.

I also had a bilateral mast for a large DCIS with multiple foci of IDC, all small but all thruout the large DCIS.  My local onc (and surgeon) said tamoxifen, but a 2nd opinion suggested some chemo first may not be a bad idea due to my young age (42) and the possibility of recurrence despite negative nodes. They could not do the oncotype on the IDC so I took the position that it could have come back as high risk, and am doing TC chemo 4x, starts thursday, then the tamoxifen after that.  That way I won't wonder should I have done it.

  Seems like there are lots of opinions, the choice is yours ultimately.

yh in nj