@srobinet - your situation is certainly very difficult. Especially with a 40 year old special needs son. I more than feel for you. Everyone diagnosed with breast cancer ultimately does what they feel is best for them - to have the best possible outcome in dealing with their particular medical situation. No one can tell you what to do - hopefully one gets the best oncology team possible to explore all options. You have the final say...however, you did ask for opinions. If in your shoes, I would definitely have the bilateral mastectomy. A lumpectomy can and does come with its own set of possible complications. I won't list them here. You must know them...I wouldn't take any extra "possible" chances of a lumpectomy not doing the complete job of removing the poison in your body. And I would not even chance reconstructive surgery. Again, full of more "possible" complications you don't want or need. Hopefully you will get your VA referral to go outside their system for another opinion. Do your research to try to establish care with a top cancer facility. Hopefully all will work out well - and such a facility will not make you "wait" & get your medical ball rolling ASAP. And I am "assuming" you are getting all your ducks in a row re: the care of your special needs son now...which will give you peace of mind he will immediately be taken well care. I know, extremely difficult to even think about this, but it's reality and, again, you know this already. I am wishing you and your son only the very best in life. Stay strong and get lots of emotional support! And don't lose hope or faith.