My recommendations are the following:
If she is younger than 70 yr old, I would perform bilateral mastectomy with immediate reconstruction by our plastic surgeon. If she is older, a lumpectomy followed by radiation therapy and adjuvant chemotherapy. The role for pre surgical chemotherapy is only indicated for metastatic axillary lymph nodes detected at the time of the original diagnosis or to shrink the tumor in preparation for the mastectomy.
Massimo Arcerito, MD, FACS