@DiKat - The decision between WLE (lumpectomy) versus mastectomy wasn't set from the start for me. I expected a Mx of my right breast because I had extensive DCIS. However, my first surgeon suggested I could have a WLE, and if I didn't get clear margins, I would then have a Mx (no re-excision to shave the margins). I was quite concerned about appearance, post-lumpectomy, because so much tissue -- at least a third of my smallish (36B) right breast -- was going to be removed. When I spoke to another surgeon at my hospital who does reconstruction herself (and thus could talk about immediate reconstruction as an option), she felt far too much tissue needed to be removed to make WLE a viable option, cosmetically. She also felt that because I am a lifelong non-smoker and had no lymph node involvement (and so probably wouldn't need radiotherapy on that side), I was a very good candidate for skin-sparing and nipple-sparing Mx with immediate reconstruction using a prepectoral implant, which is what I ended up getting. Thankfully, the nipple sample she took was cancer-free, so my nipple didn't need to be removed in a subsequent surgery. I am over the moon that this worked out, as I knew from the moment of diagnosis that I wanted reconstruction if I had a Mx, but the idea of having 2 major surgeries more than a year apart was overwhelming to me. There's always a chance that the reconstruction fails, or for some other reason I either have to go flat or have another reconstruction, of course, but at least we've tried this first. That helped reduce my anxiety.
I have (had?) bilateral cancer, and the tumor in my left breast was removed via WLE / lumpectomy, since the IDC wasn't accompanied by extensive DCIS. (The IDC in the left breast was actually bigger than in the right breast, go figure.) There was some question about proximity to the nipple on the left, and whether I'd need to have a WLE that removed the nipple, too, in which case I wondered if having a Mx was the better option. Plus, having synchronous bilateral breast cancer puts you at higher risk of recurrence, so we did talk about bilateral Mx. But I knew I'd get radiotherapy on this side, and WLE + radiotherapy is just as effective as Mx.
In the end, I opted for WLE on the left because I wanted to try to preserve nerve sensation in one breast, if at all possible. (With WLE near the nipple, there is a chance of losing nerve sensation altogether, so this was a gamble.) I also trusted that they were going to stop every bit of estrogen production in my body -- I'm getting Zoladex to turn off my ovaries and an aromatase inhibitor -- which, fingers crossed, will help keep the ER+/HER2-neg cancer on this side from coming back. And I'm getting bisphosphonates, too.
My Mx-recon side looks so good that I joke with my team that it puts my WLE side to shame and I ought to have gone for a bilateral Mx. If appearance was my main consideration, that would be true -- but I did retain nerve sensation in my left breast, and some in my left nipple, even, and that was a big part of my decision. We'll see how the tissue holds up after 20 sessions of radiotherapy...
In the end, it's all about the medical decision that makes *you* most comfortable and confident, that gives you the most reassurance. My thought process, and the things I took into consideration, may be completely different to your own. My surgery thread had at least one woman struggling between WLE and Mx, and she finally decided on Mx -- and though it wasn't medically necessary, her surgeon completely supported her in her choice. I'm sure the same is true when it comes to bilateral Mx. Alas, there's no perfect choice, not yet, anyway -- and oh, how I wish cancer treatment was evolved to allow you to just turn off the cancer cells and keep the breast as-is!
Edited to Add: If you are interested in research on effectiveness of WLE + radiotherapy versus Mx, let me know. I did a bunch of reading on this, and I recall there are lots of resources on it (I looked at UK sites, like Breast Cancer Now and Cancer Research UK, as well as US sites, like the Mayo Clinic), but I didn't bookmark stuff. I also read Kristi Funk's book, Breasts: An Owner's Manual, and some of the journal articles referenced in it.
I'm definately changing oncologists after FEC 3 next week. As my current oncologists day on the chemo suite is Monday I have to have bloodtests on the previous thursday. But if I swapped to an oncologist who's day was wednesday I would have blood tests on Monday like you. Thats an extra 48 hours for blood levels to recover. I'll do anything to try and stop it being delayed!! Are you getting used to your wig now? It looks great by the way, very natural. I had mine trimmed but think it needs a bit more off...although maybe I need to wear it for a while to get used to it xx