Recommend Bil Mastectomy for DCIS?

[Robindcis]

I was just diagnosed with DCIS L breast (well-differentiated).  Margins were postive, so I'm going back to OR for further excision.  I have no emotional attachment to my breasts (and actually hate them because they are too large and painful).  I was planning on breast reduction surgery prior to this diagnosis (hoping to go from DD+ to B), but now I'm really interested in  Bilateral Mastectomy (perhaps skin-sparing or nipple-sparing, if appropriate) with reconstruction.  I also have fibrocystic breast disease, have lots of "lumps and bumps" in my breasts, have had several other biopsies (fibroadenomas).  Of note, my mammo, u/s, and MRI were normal.  Does pursuing Bilateral Mastectomy seem reasonable in my situation?  Would most insurances typically cover the costs?

Thanks for your help, Robin

[Kamal S Saini, MD, MRCP (UK), DM]

Hi Robin,
You have been detected to have DCIS, and I strongly recommend that you take the appropriate treatment for it. This would typically include a revision surgery to obtain clear margins, whole breast radiation therapy, and tamoxifen in case the DCIS is positive for ER or PR (Estrogen Receptors, Progesterone Receptors).
There is good clinical data to prove that this combination treatment will confer benefits beyond mere surgery, so please do consider RT and hormones (if you are receptor positive).
Coming to your other question "Is bilateral mastectomy OK for me; I have large painful breasts", well this is for you and your surgeon to discuss and decide. I am a medical oncologist, and I will only advise you again to complete the recommended treatment for DCIS.

[Robindcis]

Addendum to above question:  I am 41, completed childbearing (via IVF...Fertinex, Estrogen, Clomid, Progesterone exposure), am adamantly opposed to radiation and am reluction to use Tamoxifen.    -Robin