Dear Kathy Q: If the margins are positive, meaning that there are cells within 1mm of the sliced edge, then more definitive treatment would likely be recommended. Likely, the recommendation will be mastectomy - no radiation needed if all is DCIS. Mastectomy is recommended for DCIS when it is multifocal (has more than one focus), involves a lot of breast tissue (such that a lumpectomy will be disfiguring), or is the choice of the patient. If mastectomy is the recommended treatment, you may wish to meet with a plastic surgeon to discuss reconstruction options.
the report of a biopsy can only tell whether cancer is at or within the margins; it can't say what's beyond the margins, since the margins are the edge of what's removed. Mastectomy is definately a consideration when clear margins can't be obtained; what's at issue, really, is the amount of tissue removal required to get to clear margins, compared to what's left. If the amount needing removal is such that the shape of the breast would be significantly affected, then the main advantage of breast preservation -- appearance (without needing reconstruction) -- would be lost.