Can't make a decision

You have great questions and this is a great place to ask them. The right surgery is the one that helps you sleep at night. If the spot is in one place (I had the spotty kind that showed up in more than one place), then the standard of care is lumpectomy followed by radiation. The survival rate is actually slightly better for that than mastectomy alone and the recovery is MUCH faster. I know. I had a lumpectomy + biopsy that showed cancer in two spots so then I had the mastectomy. With a lumpectomy the surgical spots could be covered by bandaids and I went for a mile walk the next day. With a mastectomy I had to have general anesthesia and it took a week before I was ready to walk around outside on my own. Reconstruction is more surgery and how much recovery it takes depends on what you have done. Most plastic surgeons are artists that continue to see you till you are satisfied with the end result. Insurance pays, but you want to check with them BEFORE any surgery so that you know exactly what they will and won't cover (days in the hospital, private or 2 bed, office checks, where you can go for treatment...). Radiation means you will be tied up for several weeks going for your treatment, but I understand it is not so bad. One of the teachers at my school had radiation and chemo throughout the year and missed only 2 days of work the entire year. Other folks need the year off. The chemo and radiation are determined after your final surgery and the decision is based on the size of the tumor, the aggressiveness of the tumor based on markers the pathologist checks, and whether the lymph nodes are involved or not. While the cancer is being removed, the surgeon also samples the lymph nodes. Standard of care I think is a sentinal lymph node operation where only one to three nodes are removed, however, not all surgeons are trained to do this operation. The old standby is to remove all the first level lymph nodes (like 10 to 20. Um, more is not better but missing cancer is not good either. If they don't have lots of these operations under their belt, you can go elsewhere or do the old stand-by. If cancer shows up in the sentinel node, you have to have more nodes out to adequately stage the cancer and see how aggressive it is. Either way, you need to take extremely good care of the involved arm for the rest of your life so that you avoid lymphedema (swelling of the arm). I had the mastectomy and the sentinel lymph node operation as day surgery and could reach over my head by the second day. I did not have reconstruction though. I had heard there would be pain, but it was more like a sore muscle than a toothache. Folks who have had reconstruction tell me they woke up feeling like they had been hit by a truck (they had the DIEP flap or tram flap kind). They did not need a prothesis and I do. The right decision there is up to you. If the lumpectomy shows dirty margins, you have to do it again (fairly common), but you can usually get it right without losing your breast. I was small and had cancer in 2 spots. I didn't have a choice. So which choice is right for you? I would do the one that helps you sleep better at night. Just know that more tissue removed does not equal less chance of cancer. It will reduce immediate reoccurance if a spot was not showing up on the mammogram. However, local reoccurances are not the same as Stage 4 cancer. If they happen, a mastectomy can be done (or a lumpectomy if you are built large enough). Radiation can only be done once. I was premenapausal when this happened to me. Tamoxifen is the standard of care if you still have periods. You can take more effective hormone pills (Arimidex, exemestane and others) once you are menapausal. Hot flashes keep your feet warm in the winter when you have to run to the bathroom. I dress for warm weather and wear layers that are easy to take off. Tamoxifen gave me an initial headache for two days that Tylenol stopped cold and a few hot flashes, nothing bad. I lost weight after starting an exercise program and got serious about eating right. I gain weight everytime I eat till I'm totally full and then eat dessert. I tried blaming the drugs, but Tamoxifen is used by weight lifters to cut their body fat (quite illegally!) so my doctor refused to let me blame that. Watching my calorie count surprised me. Those extra cookies I "needed" really packed on the pounds, as did the extra helpings of veggies that I thought would keep away the beast. I think that hit all your questions, but you are sure to have more. Your surgery should be within a month of diagnosis, so think about what will work for you. There is no one way that is right for everyone. Choose what works for you.

So many questions when we get the positive results and diagnosis. I got the diagnosis on 3/13/08, on 03/21/08 I had the mastectomy and in a month I started with the chemo. I didn't want to wait longer once I knew the diagnosis.
But each case is different, and what works for one person may not work for the other.
As you were told already, it's better to go with another person to the doctor's appointment, take a list with all your questions and take your time, don't feel rush to leave the office.
Previous to my surgery, I went to the surgeon and oncologist, and they answered many many questions.
Didn't you think about a second opinion? I personally didn't want to wait longer, and didn't go for the second opionion. Now sometimes I think what other surgeon would have done. My surgeon chose to remove 18 lymph nodes (thanks God all negative), but others choose to remove only the Sentinel node and one or two nodes (the more nodes they remove, they higher the risk for lymphedema). But then I remind me that I made the best decision I was able to do in that moment and I won't have any regret about it.
This is scary, but we have to fight and go through and win the battle!! I wish you the best.