Bilateral Mastectomy and Radiation

[jviva]

I am in my early 40s.  I had stage 3A cancer in one breast diagnosed in December 2006.  They tried twice to get a clear margin and could not.  I had 5 lymph nodes that were cancerous of the 22 they removed. My doctors decided to do chemo first then reconstruction and radiation.  I just finished chemo 6/6/2007.  I have done a body scan; there are no signs of cancer anywhere else in my body.  I did genetic testing, and the geneticist said I have no genetic predisposition to cancer ( my family history is clean).  I have had an MRI of the "other" breast, it is not suspicious, but has a 4 mm focus of enhancement which they believe to be a fibro adenoma.  However, they said the spot in my cancerous breast was a fibro adenoma for 2 years.  I have had cosmetic implants since my twenties.  
I have been convinced to do a bilateral versus saving one breast and losing one breast, because the fear of cancer is too great for me.  I could do one breast, save the second, and do extensive monitoring.
I now have to decide on reconstruction or radiation first.  My plastic surgeon says I have enough TRAM flap to do one breast but not two.  I am a D cup and athletic (even though the past two months I stopped exercising and have gained 15 pounds in my waist) and only 5'2".
I would prefer to do a TRAM flap into both breast, even if I become a B cup, because I have heard that radiated natural skin fares better cosmetically.  I've also been told that saline implants do poorly under radiation, and that some infections and tears in the skin can occur.  However, I don't believe I could go 6 months to a year with the implants removed without severe psychological distress.  I am not vain, but I have a psycho-chemical component that lends me to deep depression.  HELP!
Do I do radiation first, then reconstruction?  Or vice-versa?  Reconstruction with natural flap or implants?  The consmetic effect is a major concern.
Has anyone else had this course of action?

[relax100]

My girlfriend did a double masectomy and then reconstructive surgery.  Now she is in chemo.  Since she is lymph node negative, the recommendation was CMF chemo instead of AC chemo as CMF has fewer side effects.

She did a latissimus flap and seems to have worked out well.  You may want to ask about that.