For once, Truman and Churchill were probably not exaggerating: that "46,000" was the estimate of _Allied_ casualties in an invasion of the home islands. According to the Okinawa Prefecture website, 200,000 people were killed in the invasion of Okinawa Island alone. http://www.pref.okinawa.jp/syakaihosho/I-e.html
The present population of Okinawa Island (~ 450 sq mi) is just over one million. The US forces lost 10-15,000 killed --- this is not counting the wounded on both sides.
I think the idea that the Japanese leadership was unanimously ready to surrender is not borne out by the three day interval between the two bombs.
Another option, I guess, was a blockade and the effect of that on the civilian population would have been terrible (e.g. Iraq between 1991 and 2001).