what are my options

i am 48 yrs old, i had  nipple flattening approx. 1 yr ago this progressed to nipple retraction and flattening of my upper R breast,mammogram this yr was graded 0, i had 2 mammograms,2 ultrasounds no identifiable lump,increased density. i am 2 1/2 yrs post menapausal HRT for 5 yrs, i had premature ovarian failure begining at approx 36 yrs. i cant have MRI due to a spinal implant. I also have a swollen lymph node underarm of other breast. I had a exisonal biopsy of nipple and r lower breast,my dr assistant called w/results said it wasnt cancer but that i had atypical hyperplaysia and the dr would go over pathology report and treatment plan at follow up,will they want to biopsy that lymph node now?(rated 2 in appearance) i've read they follow you with mammogram and MRI I had extremely dense fibrocystic breasts before menapause which i don't have now ,ultrasound showed no cysts but now increased density.I had 2 kids ,only nursed1 started my periods at 11, smoked for 30 yrs,without MRI how well will they catch changes , masectomy scares me alittle but cancer scares me more.Do they ever do preventive  masectomy? breast cancer gene testing to determine my risk?

[Cleveland Clinic]

Atypical ductal hyperplasia (ADH) is a condition in which there is an overgrowth of cells within the duct and the pattern of their growth is atypical. It is not cancer or precancer but its presence is considered to increase a person's risk for developing breast cancer in the future. Decisions regarding how best to follow up for breast cancer will be based on what the findings of the testing, and what might be most appropriate for the individual.  In your situation where MRI is not an option, that does not mean that there is nothing that can be followed by other testing such as mammogram and or ultrasound. Follow-up is best discussed with your doctors who have seen your films and test results and can discuss with you the best method of following. The decision to do prophylactic (preventive) 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.  Another option is to discuss with a genetic counselor who can help determine risk and whether genetic testing or prophylactic mastectomy would be appropriate options to consider.