How do I begin to talk about what was truly the darkest period in my life? By telling you that there was a bright ray of hope that I held on to for dear life. That ray of HOPE was Dr. Armando Soto and what he said he could do to help me. Perhaps if I tell you my whole story, it may help you understand why I'm so grateful to Dr. Soto.

In January 2001 I was 56 years old, divorced 20 years, had 2 grown children, ages 31 (son) and 29 (daughter) and 3 grandchildren, ages 7, 6 and 1. My significant other, Ed, had been in my life for 17 years and I was looking forward to retirement. I was relatively fat, dumb and happy so to speak. In Jan. 2001 my whole world was turned upside down, when I went for my annual mammogram. I had been going to the same lab for 15 years. They asked me to wait for the results. The doctor came out and said he found a cluster of 10 to 12 calcifications in my left breast for which he thought I should get a second opinion. I really wasn't too upset. When I got home, I immediately called my gyn (a female) and asked what I should do. The doctor's physician assistant was very helpful. I said I wanted to go to whomever the doctor would go to with this problem. She arranged for me to see Dr. Eric Whitacre, a breast surgeon in the Breast Center at Mercy Medical Center in Baltimore.

In early February 2001 I saw Dr Whitacre and he recommended a biopsy, although he could not feel anything. He said there was an 80% chance the tumor, if there was one, would be benign. Due to my weight I had to have a surgical biopsy in late February. I had twilight sleep and no side effects from the anesthesia. In fact, afterwards I went out and had a big breakfast. I could do that because anesthesia tends to be eliminated by my body quickly. This is not true for everyone. About a week later I got a call from Dr. Whitacre saying that they found a 3.8 mm cancerous tumor. It was Stage I A. Dr. Whitacre stayed on the phone with me for 45 minutes trying to comfort me and tell me things were not hopeless at all. I thanked him, got off the phone and said to myself, "My God, I'm going to DIE". I think this is what we all say, when faced with this diagnosis. Life becomes a very dark place and you are overwhelmed with a feeling of utter fear and helplessness.

I went in to see Dr. Whitacre with my daughter about a week later. Always go to these appointments with someone else. You won't hear or understand half of what is said. Dr. Whitacre was very positive, saying my cancer had been caught very early and the prospects for a good outcome very favorable. He discussed 2 options, a lumpectomy with radiation, or a mastectomy. He also recommended removing and testing lymph nodes to see if the cancer had spread outside of the breast. He asked if I wanted to be part of a Sentinal Node Trial. I decided on the lumpectomy with radiation, and both the axilliary node dissection and the sentinal node procedure. I opted not to be in the Trial. The nodes I'm talking about are located under your armpit. I have to say that Dr. Whitacre was extremely caring and sensitive. He never made me feel rushed and answered all my questions. He actually encouraged questions.

Prior to the surgery I met with Marsha Oakley, the RN on staff who meets with all patients facing breast surgery. She is also a survivor. Basically she told me what to expect during and after surgery. I also met with the Rehabilitation people at the hospital. They gave me exercises to do after the removal of my lymph nodes. They also took measurements of my arms, so they could tell if I came down with lymphadema at a later date, which can happen at any time, after nodes are removed. They also provide you with a list of Do's and Don'ts. You have to be careful of what you do with the surgical arm for the rest of your life. Even the removal of 1 lymph node can cause problems in some people. I also had to have a complete physical. Lucky for me, at Mercy they go out of their way to schedule all of these appointments for one day, so you don't miss too much work. Marsha gave me a video and companion book entitled, "Be a Survivor" about surviving breast cancer. It had a lot of interviews with BC survivors and was quite informative and I would recommend watching it with your spouse or partner. The comments made by one woman became my mantra after my lumpectomy, when I knew I'd be facing a mastectomy.

I was scheduled for the lumpectomy on March 19, 2001. Surgery was about 2 _ hours and done on an outpatient basis. It was not terribly uncomfortable except for the lymph node removal. I felt like I had a baseball in my armpit and that feeling lasted for about 2 months. Lucky for me Dr. Whitacre's surgical approach to node removal is to work around the nerves surrounding the nodes, rather than to cut through them. It adds about 45 minutes to the surgery, but it sure helps the recovery process. You hear horror stories about women having problems lifting their arms, but I sure didn't. At first you are all numb under your arm, but in 4 to 6 months I got all the feeling back under my arm. I can't speak to other people's experience, but this was mine. I started the exercises, when recommended by Rehab, and can lift my arm completely over my head like before. However, I do have to be careful about how much I try to lift with that arm and always will. I can no longer use that arm for taking my blood pressure or drawing blood. The restrictions are no big deal, they're just something you have to get used to.

I went in for a follow-up appointment in about 10 days and that's when I got news I wasn't very happy to hear. The lumpectomy revealed 3 more tumors, the largest being 1 cm. Apparently, 1 cm is still considered very small and an early stage cancer. I had infiltrating duct carcinoma. Dr. Whitacre said he couldn't guarantee there weren't additional tumors in the remaining breast tissue. He took out 30 lymph nodes and they were all negative. Thank heavens. I asked why he took so many nodes and he said he has to take a prescribed area of tissue and that's how many nodes were in the tissue he took. Some people have more and some have less. You can't tell ahead of time. He gave me a copy of the lab pathology report. It came back with positive receptors for estrogen and progesterone. I was a candidate for hormone therapy. Dr. Whitacre discussed a mastectomy as an option. He also said that Mercy's plastic surgery department used the state of the art techniques for breast reconstruction. I had no idea what that meant. As it turns out, Plastic and Reconstructive Surgery is located right next the Breast Center. Before I made any decisions, Dr. Whitacre insisted on me consulting with three other doctors, a radiation oncologist, a regular oncologist and a plastic surgeon.

Here's where Dr. Soto arrives on the scene. He was the first of the three doctors I was scheduled to see. My appointment was almost 2 hours long. The nurse seated me in an office with a TV. I went to these appointments with one of my oldest girlfriends. Be sure to take someone with you. I spent the first 15 minutes watching a video which discussed mastectomies and the various types of reconstruction available. There are quite a few options available, which can be done immediately. You wake up with a new breast of sorts, or it can be done at a later date. Personally, immediate reconstruction was what I knew I wanted, if it was available to me. The options I remember are implants, which on average have to be replaced in about 10 years, reconstruction using muscle from your back, using muscle from your abdomen or the DIEP tram flap, which uses only the fat and some blood vessels from your abdomen, resulting in a tummy tuck. Now that sounded good to me. As I was very large, a DDD, I would be eligible for a breast reduction on the other breast. Not a bad tradeoff considering the circumstances.

Then I actually met Dr. Soto. I can only say he swooped into the examining room sporting a big smile and a positive attitude. I took one look at him (he looks like a teenager) and the first words out of my mouth were, "How old are you?" He was silent a moment, turned a little red, and then went on to give me a detailed rundown of his medical training, but he never said how old he was. I believe he went to medical school at Johns Hopkins, did his residency at a plastics surgery hospital in St. Louis, a Fellowship with Dr. Bernard Chang, the head of plastic surgery at Mercy, and is now an associate of Dr. Chang. He looked at my pathology report, examined me and talked about what would work for me. He thought I was a good candidate for the DIEP, which he described as the state of the art reconstruction surgery. He explained how the operation was done. It involved moving blood vessels and fat from my abdomen to the breast cavity and reconnecting everything via microscopic surgery. Your navel is also moved, otherwise after surgery, it would be somewhere where the sun doesn't shine. It was about a 9-hour operation. He also explained that, about 2 months later, he would create a new nipple (no skin graft is involved) and do the breast reduction in a second outpatient surgery. The only downside was that there would be no feeling in the reconstructed breast, but without it there would be no breast at all. Lastly, he brought in a book of before and after DIEP procedure pictures. I was highly impressed with what I saw. I almost made my mind up on the spot. Dr. Soto answered all my questions and encouraged me to call him at any time I had new questions. He did not guarantee success, no doctor can. However, he did say he doesn't dwell on failure because most of the DIEP operations he does are a success and there was no way he could predict who it won't work for. He told me he had done approximately 150 DIEP reconstructions up to that point in time. I appreciated his honesty. Recently he told me he does from 1 to 4 DIEPS a week. Everything he says is positive and upbeat. I have to say I left this appointment much happier than when I arrived. For the first time I had some HOPE for a happy future life. My friend was equally impressed with Dr. Soto. She's in her 60's and said she would trust him.

From this appointment I went to my appointment with a female radiation oncologist. She also read my lab report and although I had clean margins, she was not comfortable with them and not sure that radiation would catch all the stray cancer cells, even if I had a second lumpectomy, taking more tissue. Clean margins means there are no cancer cells on the edges of the tissue removed from your breast. My margins were almost non-existent, plus they found 3 additional tumors, the largest being 1 cm. We talked at length and I finally asked what she would do. She said she would have a mastectomy. Well, didn't a dark cloud instantly descend on me? To say I was a little depressed is an understatement. However, I shutter to think of how I would have felt if I had not already met the upbeat Dr. Soto. Like I said, he was my ray of HOPE throughout this ordeal. In the car ride home, I cried a little.

Two days later I met the regular oncologist. He was very nice, but all business. He also read my report and said that if I had a mastectomy and they did not find any other tumors larger than 1 cm, I would not need radiation or chemo, per the latest cancer treatment guidelines. As I have positive hormone receptors, the only treatment he would then recommend for me was tamoxifin for 5 years. All in all this wasn't a bad scenario. If I had immediate reconstruction, I would come out of this mess with a tummy tuck and a breast reduction. If luck was on my side I wouldn't need radiation or chemo. I might even be perky again, not that I can honestly recall ever being perky. Still it was a depressing experience. No one wants to be one of those people who needs to see an oncologist on a regular basis for the rest of their life, or they stand a good chance of dying sooner rather than later. With a heavy heart, I walked to the parking garage with my friend. I got into the car and the flood gates opened. I finally remember saying to my friend; "I don't have any real choices, but to get a mastectomy". I never really said, "Why me!" because I know life isn't fair. Then I thought of Dr. Soto again, and knew instantly I was going to have the DIEP procedure and immediate reconstruction. There was no hesitation, only HOPE! It occurred to me that after the reduction I could go shopping for new clothes. As you can tell, I tried not to feel sorry for myself.

When I got home, I called Dr. Soto's office. His assistant, Debbie, coordinated making all the arrangements. My surgery was set for 7 AM, Thursday, April 19, 2001. It's not a date I will ever forget. I had 2 weeks to do nothing but think about losing a breast. This was such a difficult time to get through. I did see Marsha and Dr. Soto again to talk about the surgery. I was concerned about the DIEP because I had had a total hysterectomy 2 years earlier. There was a chance that blood vessels critical to the success of the DIEP surgery might have been cut during the hysterectomy, but Dr. Soto was thought that the blood vessels in the original surgical area, he needed to move, were in all likelihood still intact and uncut. He said Dr. Chang had only a couple of instances where the blood vessels in question had been cut and, therefore, unusable. I asked, "What then?" Dr. Soto said he'd still finish the tummy tuck, but we'd have to reevaluate what to do next. He could always go to my buttock for the fat tissue, but I'd have to wait at least 30 days to do the surgery. The thought of waking up with no breast filled me with dread. It just wasn't something I wanted to have to experience. I had resigned myself to a mastectomy, because I knew I was going to a new breast when I woke up. Dr. Soto saw how upset I was and went on to explain that there are actually 2 such blood vessels in your abdomen he could, and the likelihood that both blood vessels would be cut was remote. From then on, whenever anyone asked if they could do anything, I said pray for blood vessels. They looked at me strangely and I'd then explain what I was talking about.

Emotionally, I wasn't in great shape, but I tried to stay positive. There were several things I kept telling myself to get through each day. The first was that I wasn't having a mastectomy, I was having a breast reduction and a tummy tuck. At least that could make me laugh a little and I could joke about it with other people. A lot of my women friends were offering to donate their abdominal fat. You have to be able to laugh a little about the situation to stay sane. The second thing I kept telling myself was that my breast had been my lifelong friend and companion, but it had turned on me and was now my enemy. If I didn't get rid of this enemy, it would kill me and not think twice about it. I figured I didn't have any choice, but to get rid of it. The night before surgery was a reflective time for me, a few tears were shed and then I went to sleep knowing I'd never go to sleep with my left breast ever again. The strangest thing of all is that I got a good night's sleep.

I was up around 4:30 AM to take a shower. No food or drink after midnight. I had a lot of family support during this time. My parents, who are in their 80's and my sister came from NY to be with me. Ed was there as were my 2 children. You could say we took up half the waiting room. As soon as I got to the Pre-Surgical Area, they took me back to take medical history, and put in an IV, so they can administer any drugs they needed me to have. Once I was all prepped, they told me I was to go up to Dr. Soto's office to be marked. They wheeled me up and my sister and daughter came with me. I was taken back to the examining room and then Dr. Soto took out his big purple pen. I was marked up from my chin down to just above my pubic hair. Apparently, he needs these marks so he knows where to place everything during surgery. Afterwards, my sister and daughter came back to meet Dr. Soto. While I was being marked, my sister was scanning Vanity Fair to find me a new set of breasts. She wanted to show them to Dr. Soto. Anyway, she found them and I really liked them too. So after the introductions were made, my sister whips out the magazine and shoves it in Dr. Soto's face, pointing to the set of breasts she found. She then asked him if he thought he could give me the same thing. Again, he was taken aback for a moment, looked at the picture and said, "Yes, I think I can". Then we all cracked up laughing. It helped break the tension, which my sister later told me was just what she was trying to do. The great thing is that he pretty much did what he said he could do.

We went back to Pre-Op and basically, everyone was able to come in and wish me well. A surgical nurse came, took my glasses and walked me down to the operating room. Talk about feeling like you're walking to your doom. Once in the operating room, everyone was cheery and said hi, in their green surgical outfits and masks. They told me to hop onto the table, which I did. I reminded the anesthesiologist that I wanted to go out slowly. I hate it when it feels like someone just put the lights out. He did just what I asked. The next 9 1/2 hours were much harder on my family than me.

The next thing I knew I was in Recovery. All I wanted to know was where's the morphine button. You self medicate yourself for pain. Don't be afraid to use it, you can't get hooked. You're allowed only so much medication at a time, no matter how much you push the button. Here's a hint, try to stay ahead of the pain. It will keep you more comfortable. Don't try to be a martyr. It serves no useful purpose. I think I was still drowsy in Recovery. My first real moment of clarity was when I was in the ICU Unit. All patients go to ICU after this surgery. I was there about 12 hours before I was transferred to a private room on a different floor. All the rooms are private and they will bring in a cot, in case someone wants to stay the night. Anyway, when I woke up, my whole family was at the foot of the bed staring at me (it was about 9:30 PM). I looked at them all and said, "Oh my God, I feel like I've been hit by a mack truck". They all said something to me and said they'd see me in the morning. I said sure and went off to sleep.

About an hour later a nurse came in to take my vital signs and then hooked me up to a machine, which made a whooshing sound. It turns out that during surgery they inserted a little wire that acts like a sonar unit that tells them how the blood is circulating in the newly attached blood vessels (you know, the one from my abdomen I was stressing over for 2 weeks). I also came out of surgery with 3 drains, one on each side of the abdominal incision and one under my armpit, coming from the new breast. Speaking of your armpit, you will find a large lump under your armpit, next to the new breast. This is often referred to as a "dog ear". According to Dr. Soto, its extra fat that is put there to protect the newly attached blood vessels. Most of it gets removed when he creates your new nipple. Its not really painful, just annoying because you're not used to having anything there. The drains were emptied several times a day and you go home with them. Yes, you have to empty them at least twice a day at home for about a week. They help reduce swelling. The wire in the breast goes home with you too, but you don't have to do anything with it, and it doesn't hurt. They also catherize you during surgery. It stays in for about 2 days. I didn't mind because walking to a bathroom was the last thing I wanted to do. You have a private bathroom. They do make you get out of bed within a day or so and sit in a chair.

From a pain standpoint, the one thing that bothered me more than anything was a nagging headache, from the time I woke up from surgery. All they would give me for it was Tylenol. I think it was a drug related headache. After the first 2 days they took me off morphine and put me on percocet, in pill form. The nagging headache continued. I asked for Advil. I found out the hospital doesn't carry Advil. Finally, I was able to get a doctor to prescribe the generic form of Advil and my headache eased up some. I finally stopped taking the percocet altogether because I thought it was causing the headache. (Ladies, if you use Advil for headaches, be sure to make arrangements to have it around if you need it.). The second morning I was home I woke up headache free and stayed that way.

The pain from surgery is very manageable as long as you take your medication on time. Don't let the pain get ahead of you. I was in the hospital 4 days after the day surgical date, and by the time I left I was relying mostly on Advil. I also had to walk a little bent over because of the tightness due to the tummy tuck. They sure do pull the skin tight. Over the weeks and months, things loosen up and you return to normal. I can even do sit ups now with no difficulty.

Overall, my hospital stay was good. Be sure to bring one of your pillows from home. The doctors and nurses are really nice. Dr. Whitacre even sent flowers. When's the last time a doctor sent you flowers?

I was able to go to the bathroom on my own by the third day. I was released the afternoon of the fourth full day. You will be asked to wear a camisole for the next month. You're sent home with two, one to wear and a spare. There are little pockets in it for the drains. Its very comfortable. A word of warning for the ride home. Be sure to put a pillow across your chest before connecting the seatbelt. I used a pillow across my chest for 6 months. Marsha Oakley gave me a heart-shaped pillow, which worked perfectly.

From the time I got home, I was able to go up and down stairs for meals. However, bed rest is the best way to heal quickly, at least for the first couple of weeks home. Every day got better and better. I was home a total of 6 weeks. The last 2 weeks I worked half days from home. I have a desk job. When I went back to work, it was full time from the start. Boy, was I tired at night. As time goes by, the swelling goes down.

I didn't look at my new breast until I got home. It was a little strange looking, with no nipple and it was quite a bit smaller than my other breast (the DDD one). There was also a circle of skin where the nipple should have been. Per Dr. Soto, this little circle of skin is abdominal skin, still attached to the fat underneath. About 8 weeks after my mastectomy, I had an appointment where Dr. Soto removed the little circle and stitched the breast skin together. He said he needed to do this before creating the new nipple. Apparently, you don't leave breast skin next to abdominal skin. It took about 15 minutes, under a local and was painless. It didn't slow me down a bit. All the while, I continued to get more feeling back under my armpit. I might add that for the period between the mastectomy and reduction, I wore a breast form on my mastectomy side so I didn't look lopsided. Lisa Lawson, who's office is near the Breast Center fitted me for everything I needed, throughout all my surgeries. She is fabulous and insurance covers almost everything.

On July 3, 2001, I went in for my nipple creation and breast reduction. You go to the Pre-Op area and get hooked up to the IV again. Surgery was about 2 _ hours, on an outpatient basis. Guess what, the new nipple really does look like the real thing, only the color is missing. I was home for about 2 weeks, due mostly to the breast reduction, rather than the new nipple. In the reduction process, they remove your nipple and reattach it. There's always a chance you won't get any feeling back in it, but that didn't happen to me. In fact, it was super sensitive for a while. As it turned out, the reduction came out smaller than the reconstruction, but Dr. Soto said I could come back for final downsizing and touch ups later. It took a while for the reduction to heal, but its great now.

I took my time scheduling my final surgery. It happened on October 28, 2001. In the Pre-Op area, Dr. Soto again marked me with his big purple pen. I also asked him to remove a little extra fat from just above my navel. I didn't like looking down at it. He said no problem. I also asked him to take some more fat out from under my armpit, which he did. Surgery was outpatient and no more than 2 hours. The dog ear is gone and my breasts match as close as they can. Ed thinks they look great. I stayed home from work 1 day. If you schedule surgeries for Thursdays or Fridays, it cuts down on the time you miss from work. Now all I had left to do was get the new nipple tattooed.

On December 28, 2001, I did just that. Dr. Soto's nurse did it in about 45 minutes. I didn't even need a local, since that area of the breast has no feeling anyway. I would recommend that once you remove the initial gauze she put on it, you buy some non-stick gauze, so you don't remove the new tattoo, which is healing. You can't take a shower for the first couple of day either.

Now I'm all done and, of course, Dr. Soto had to take an After Picture. Thank heavens there are no head shots or names associated with the pictures. I really do look better than before. I don't even notice the reconstructed breast any more. It looks and feels just like the real one. It will also get bigger or smaller, if I gain or lose weight. I'm even starting to get some feeling in the skin on the top part of the reconstructed breast I'm now a "C" and perky. Imagine that, perky at 57! I'm not even sure I was ever perky, but I am now and my back and shoulders are loving life. The backaches I had for years are, for the most part, gone.

As I said in the beginning, I took a journey into total darkness and came back into the light a very happy survivor. I had my first annual mammogram after this journey in January 2002, and everything was normal. I don't know what the future holds for me, its in God's hands, as it has been from the first, but I'm delighted with the final outcome to date. Dr. Whitacre, Marsha and the entire staff at Mercy were wonderful, but my special thanks go to Dr. Soto. He's one in a million and I won the jackpot.