Thank you for your question! This scenario is becoming more common. It is a tricky situation, and one that should be discussed with a breast surgical oncologist. It hour the diagnosis of breast CA or (+) genetic testing, it is difficult for coverage and usually not performed as an elective procedure. Diligent self examinations and routine radiologic imaging is warranted and recommended.
This is becoming a more common issue. As you can imagine there are several cases very similar to yours. I have been involved with cases where a strong family history and a patient who kept having biopsies ultimately had bilateral mastectomies. Having a consult with a breast surgeon and medical oncologist may beneficial. I hope this helps!
If you are high risk for breast cancer, a prophylactic mastectomy may be indicated. This is something you should discuss with a breast surgeon. A decision to have prophylatic mastectomies should be made after weighing the risks and potential benefit in risk reduction. Mastectomies are usually covered by insurance.
The decision to have prophylactic mastectomies is a complex one and I encourage you to discuss your risk and options with a medical oncologist and breast oncological surgeon. If it is still a consideration, then you should discuss this with a plastic surgery to determine how your reconstruction could turn out with all the available methods of reconstruction. If your breasts are simple to reconstruct then perhaps the threshold to proceed with mastectomies might be lower. It is important to understand that breast reconstruction surgery is not breast augmentation surgery.
The use of breast fat grafting in my practice for total breast reconstruction after mastectomy has proven to be an appealing option for patients undergoing prophylactic mastectomy.
I completely understand your point of view, and suggest speaking to a breast surgeon more in depth about your risk and wish for a prophylactic mastectomy. Bilateral prophylactic mastectomies with reconstruction should be covered by your insurance, if the surgery is indicated. Good luck!