Treatment for DCIS after bilateral mastectomies

My hx:

Borderline Phyllodes tumor 2X excised to get clean margins and then followed with prophylactic bilateral mastectomies because of dense breasts with multiple (too many to count) solid tumors in both breasts.

Pathology after mastectomies (with immediate saline implant reconstruction) showed atypical ductal hyperplasia near original site of phyllodes tumor.  Upon closer examination of additional slides, pathologist then found a focal area of ductal carcinoma in situ, intermediate grade that is excised to within 0.3mm of the inked inferior margin.  The dcis is both estrogen and progesterone positive.

What further treatment (if any) would you recommend for this situation as the margins are so close?  Would further surgery to remove the adjacent skin be reasonable?  Radiation?  Tamoxifen?

Many thanks for your assistance.

[vismar]

If you are a premenopause women you need to take tamoxifen..for radiation you need to discuss with your oncologist I would say yes...