I was forced to have silicone implants initially but got them removed afterwards, which is pretty easy to do.
If you have a mastectomy with or without implants you no longer need mammograms as any residual breast tissue is microscopic so there's nothing to image.
My implants were placed under the muscle, which does unfortunately cause some discomfort and loss of muscle function, but also means that anything that does develop would lie on top of, rather than beneath the implant, so I would choose sub muscular rather than subdermal for that reason if I had to.
But for me personally, no implants is better. Luckily I was slim so there was no possibility of carving up my belly or thighs to make a replica pair of breasts - that would have been irreversible.
Given your family history I would push for genetic testing.
Also there is abundant evidence now that vaginal estrogen can safely be used in breast cancer patients, that your treatment team should be aware of. No oncologist is on minimum wage and they have a duty to keep their professional education up to date.
However if you do face a tussle to keep your prescription, it can be bought without one of need be, which although unfair is better than going without.
