I had Pagets Disease in my right breast 17 years ago. There also was DISC stage 0. They recommended mastectomy, which I had. I recently had 2invasive carcinomas in left breast. They did what was called partial mastectomy since they took both tumors at once and did some reconstruction. If you can have nipple removed since no other cancer, especially since you are active, I would make that choice. I was 62 when I had mastectomy and reconstruction. When they did procedure to "make" nipple, it left large scar tissue that made breast misshapen. Of course, a lot has improved in procedures since then. Just sharing what I would do.