I elected to have a double mastectomy, as it turned out there was early neoplasm in the unaffected breast despite negative MRI,ultrasound and mammogram. Obviously for me double mastectomy was the right decision, however, having now been through the double mastectomy I would encourage anyone facing the decision to consider, initially, just doing what's necessary on the affected side. As has been said you can alway decide to have the other breast off when you are considering your reconstruction options. We're so fortunate to have this site to have frank discussions about options. Who else would understand.
All the best