To Biopsy or Not to Biopsy

I spoke to the Radiologist at Baylor-Irving who wrote my MRI report. She answered most of my questions and recommended a follow up Ultrasound to further investigate the loss of the fatty hilum on the axillary lymph node she noticed on MRI. I am scheduled to go in tomorrow morning for this.

Should this come back positive, she will most likely recommend an axillary node biopsy be done. My nurse at my breast surgeon's office says there is no advantage to this, other than avoiding the sentinel node biopsy at the time of the surgery (and that's only if the biopsy came back positive). The radiologist says that it might save me an additional operation. I'm thinking it might give me a better idea of whether to expect radiation or not, but not sure if knowing that is worth another minimally invasive procedure.

I also received some discomforting news regarding why the MRI came back inconclusive. According to the radiologist, I have some of the most dense breast material she has ever seen. She said that even MRI most likely wouldn't be able to detect small tumors (less than 2 cm) until they were larger. She said, should I choose lumpectomy over mastectomy, that I would need to do mammography every 6 months (despite the fact they are unable to read them), and that I could only have MRI screenings once a year (I didn't think to ask why, but guessing insurance issues or some health risk).

With the family history, prior breast cancer etc... and knowing that I've already had to have 5 biopsies in the last 7 months, I can see these screenings becoming a real hassle. They would be more likely to investigate every little thing, thus leading to endless biopsies every 6 months. Also, there is the additional fear of them not finding something deep down in the breast tissue until it is at a late stage due to the density to consider.

At this point (of course this might change as new information is presented to me, particularly after I hear what MD Anderson has to say) I am definitely leaning towards bilateral mastectomy just to be done with this and not have to deal with this over and over for the rest of my life (whether it just be the endless screenings and biopsies or an actual second cancer). Although I know this is probably the best decision, and afterwards I'd probably be glad I made it, I'm still considering lumpectomy due to my extreme fear of surgery and the pain and suffering afterwards. Right now, I'm trying to decide which is worse: dealing with the fear and hassle over and over or going through the scary process of a full blown surgery. It's like being on that old game show(was it called Let's Make A Deal or something?) where you have to pick door 1 or 2 and both have goats behind them.