Pleomorphic ILC/LCIS

I recently had a lumpectomy to remove a 2.7 cm pleomorphic invasive lobular carcinoma tumor. I am 39 years old, strong family history of cancer, including breast. The tumor is ER/PR positive, HER neg. SNB was negative. I will be having chemo/rads/tamoxifen. There is extensive pleomorphic LCIS remaining in the breast. Don't know what's in the "good" breast. The surgeon is recommending prophylactic bilateral mastectomies, basing the increased risk of local/contralateral recurrence on the pleomorphic biology of the LCIS. What is your take on the pleomorphic subtype of ILC and LCIS? I don't want the bilateral mastectomies, but I also don't want to be imprudent. Thanks in advance.

[Cleveland Clinic]

Dear nunez67:  LCIS is treated more like a marker for increased risk for breast cancer (and this risk could be lobular or ductal).  LCIS is also often multicentric and may be present in the opposite breast.  Invasive lobular cancer is treated similarly to invasive ductal carcinoma.  The management of LCIS is less clear.  Bilateral mastectomies may be recommended for women who are at high risk of developing breast cancer.  You may want to seek guidance from an oncologist and possibly a genetic counselor who may be able to help determine your risk and make appropriate recommendations.

[nunez67]

Thank you for the quick response. I have gotten the opinions of two oncologists, my surgeon and a genetic counselor, and no one wants to weigh in on how to manage pleomorphic LCIS except my surgeon. She wants to manage it aggressively due to the pleomorphic (vs. classic) cell structure of the remaining LCIS. I'm obviously high risk for developing breast cancer, as I currently have it. The current issue is local/contralateral recurrence.

[QuoVadimus]

A related discussion, Pleomorphic LCIS was started.