Should I consider prophylactic mastectomy?

Family history:  Mother diagnosed with breast cancer at age 49, died at age 53.  One maternal great-aunt diagnosed with breast cancer at age 47, another maternal great-aunt in her sixties.  Maternal aunt diagnosed with DCIS and atypical lobular hyperplasia at age 62.  Personal history:  Age 47 now, at age 43 diagnosed wtih focal atypical ductal hyperplasia and atypical pregnancy-like hyperplasia, took tamoxifen for four years and two months but then had to discontinue due to side effect of bilateral cataracts.  Very dense breasts on mammography, MRIs show patchy parenchymal and nodular enhancement with comment by radiologist that this decreases sensitivity of the study.  Negative for BRCA1 and BRCA2 mutations (tested only for three sites associated with Ashkenazi Jewish population).

My question is this:  Since I am still menstruating and therefore not a candidate for other chemoprevention, with additional problem in my case of decreased sensitivity of both mammaography and MRI, is "close surveillance" a reasonable strategy? Should I be looking at prophylactic mastectomy instead?  Thank you for this very helpful website.

[CCF-RN,MSN-JS]

Dear wuhanmom,  The decision to do prophylactic mastectomy is a very personal one. There is no absolute set of circumstances in which this is the only option. You might benefit from a conversation with a breast specialist who can discuss pros and cons as they relate specifically to you and help you to arrive at the best possible decision.