Jane, 44, was the last person anyone expected to have cancer. An active wife and mother, Jane exercised regularly, ate healthy foods and got plenty of rest. She wasn't a smoker. Along with her husband and daughter, she pursued a passion for water skiing. She enjoyed daily walks with her husband and their two beagles. But everything was put on hold the day she found a lump in her breast.

Jane's training as a physician assistant in medical gynecology led her to believe that her breast lump was most likely a cyst and would go away after her next period. It did.

But she needed reassurance, so she made an appointment with her doctor. A breast exam and ultrasound revealed nothing abnormal. However, a mammogram showed a suspicious spot in Jane's left breast, which led to a biopsy. The biopsy confirmed what Jane had feared all along: She had cancer.

Jane's cancer was ductal carcinoma in situ (DCIS), and as she would later learn, it was located extensively throughout her left breast.

Initially, Jane's preference was to have a lumpectomy — surgery to remove the breast cancer but spare the breast — and a follow-up course of radiation therapy.

Jane discussed with her surgeon the ramifications of the cancer being widespread. It was possible that they wouldn't be able to remove all the cancerous tissue with the lumpectomy. Jane instructed her surgeon to stop the procedure if the cancer was too widespread to be removed through the lumpectomy. She feared waking up from surgery without a breast. Jane made it clear that if the lumpectomy wasn't going to work — and it turned out that it didn't — she wanted to be able to reevaluate her options.

During one of her doctor appointments leading up to the lumpectomy, Jane recalled being shown a book containing pictures of women who had gone through mastectomies — the removal of one or both breasts. In it were women with reconstruction and without. Jane was a little bewildered and slightly angry that the doctor was showing her these pictures. After all, she wasn't getting a mastectomy. Later, recalling this session would prove priceless as she made her decision about mastectomy and reconstruction surgery.

After the unsuccessful lumpectomy, Jane opted for surgery to remove both of her breasts (bilateral mastectomy).

Jane realized that for her physical health, as well as for her mental health, mastectomy was her only choice. "I didn't want to have to go through the experience of being diagnosed with breast cancer again — ever," she explained of her decision to remove not only the diseased breast but also the healthy breast.

Factoring into her decision was that she could have reconstruction surgery. In fact, it never crossed her mind not to have reconstruction. For Jane, it was all part of her journey to better health.

In addition, she felt that breast reconstruction on both breasts at the same time gave her the best odds at breast symmetry.

Two weeks to the day after her lumpectomy, she returned to the hospital for her mastectomy surgery. The surgery lasted five hours, with a change of surgical teams midway through. A breast surgeon performed the bilateral mastectomy, and a plastic surgeon began the reconstruction.

Jane's plan for breast reconstruction included having tissue expanders inserted, eventually to be replaced by permanent implants.

She briefly considered a transverse rectus abdominal muscle (TRAM) flap — in which the plastic surgeon takes abdominal muscle and tissue to create a new breast mound — but she dismissed this idea because she didn't want to lose her abdominal strength. Women who have TRAM flap surgery often experience diminished abdominal strength after surgery because the surgeon constructs the new breast using a major abdominal muscle. TRAM flap surgery can lead to difficulty in lifting and performing daily tasks, depending on how much muscle is taken.

But Jane was, in her own words, "way too active" to have a TRAM flap done. Likewise, the thought of no reconstruction and using prostheses — artificial breasts she could place in her bra — wasn't appealing. She didn't want to worry about them moving out of place when she was swimming or water skiing.

The surgeon who performed her mastectomy took care to make both surgical sites as similar as possible. Because of her prior lumpectomy, Jane had already lost a fair amount of skin and tissue in her left breast. So the surgeon removed an equal amount of skin and tissue from her right breast. This gave the reconstruction surgeon equal areas to work with and gave Jane the best odds for symmetrical appearance and a good cosmetic outcome.

A few weeks after her mastectomy, Jane began the first step toward reconstruction — tissue expansion. The plastic surgeon had placed under her chest muscle saline tissue expanders — breast implants that are filled gradually to stretch skin and breast tissue — at the time of her mastectomy surgery.

"You couldn't tell that by looking at me, of course," Jane said, "but they were there. I was flat as a board, but I could feel the expanders beneath my skin."

Having the tissue expanders in place when she woke up from surgery didn't have any bearing on how she needed to care for herself post-surgically. She couldn't shower or soak in a tub, and she stayed off her feet for a while after her surgery — as she would have done if she'd just had the bilateral mastectomy. Initially, she didn't feel much discomfort because the nerves leading to her remaining skin and breast tissue had been cut during the surgery. But the tissue expansion process would prove to be quite painful.

Tissue expansion involved weekly visits to her doctor to have the expanders filled with saline. This was an accelerated pace for expansion — many women opt instead for two- to three-week intervals for the expansion injections. But Jane wanted to be done as quickly as possible. As long as she could tolerate the discomfort associated with each expansion visit, her doctor agreed to the schedule.

The drawbacks of fast-paced tissue expansion included the potential for stretch marks and moderate to severe pain.

For Jane, the pain was debilitating. It was at its worst about one to two hours after her doctor visit to fill the expanders, but significant pain continued for a period of 24 to 48 hours after the expansion. The pain was so intense that she couldn't sleep. She spent her time leaning slightly forward, sitting rigid and upright in a chair — the position that was most comfortable and tolerable for her. For those few days, everything was on hold. Then the pain would subside, and she'd return the next week to start the process all over again. This cycle went on for about eight weeks.

Jane made it through this painful time by focusing on the end result — the day when her breast reconstruction would be complete — and drawing on the support of her husband and daughter.

After the tissue expanders had sufficiently stretched Jane's skin and remaining breast tissue, she went in for another surgery. This time it was to have the tissue expanders removed and her final breast implants put into place. For the procedure, the surgeon used the scars from the mastectomy surgery to make the incisions, so Jane has only one set of scars.

The scars run horizontally across Jane's breast, not quite the entire width, and below the area where her nipple is. Fortunately for Jane, her scars are fading over time. What's more, she's gradually getting some sensation back in her breasts — more than she ever thought she'd have again.

A few weeks after her permanent implants were in place, the surgeon performed nipple reconstruction. The nipple reconstruction served to conceal her scars to a certain degree. After two tattooing sessions to color the skin surrounding her new nipples, Jane's breast reconstruction was complete.

Jane realizes the possibility that she may need to have her implants replaced at some point, for instance if she develops troublesome scar tissue or if the implants rupture. And that would mean another surgery. "But I'm OK with that," she said. "I knew going in to the surgery that they might need to be replaced." Although she plans to wait on that decision until she's faced with it, Jane anticipates that she will have her implants replaced.

The strange thing for Jane about her experience with breast cancer is that she was somewhat indifferent about her breasts — until she lost them.

"I was never a breast person," she said. "They didn't define who I was." But once they were gone, it took reconstruction to make her feel complete — and like she had returned to normal. Clothes fit the way they were supposed to, and her self-esteem improved.

There are a few things Jane has to be mindful of with her new breasts. For one, she doesn't treat her implants too gently. She massages them daily, which helps keep the tissue loose and prevents capsular contracture — a buildup of fibrous scar tissue that constricts the space where the implants are located. This can cause the breast to become rock hard, and surgery is often necessary to correct the complication.

Jane also pays attention to heat and cold, and the effect they can have on her breasts. Because she has less sensation than she used to, she takes care not to burn herself, for instance from cooking splatters. She also makes certain that she bundles up in cold weather before spending time outdoors. Because she has just a thin layer of skin and muscle sitting atop the breast implant, there isn't a lot of blood flow to keep the tissue warm. This increases her risk of frostbite and tissue damage if her breasts get too cold.

More than a year after her original diagnosis, life has settled back into place for Jane. She's up to speed at work, and she's returned to her active lifestyle. In fact, on the one-year anniversary of her diagnosis, Jane marked the occasion by participating in a three-day, 60-mile breast cancer walk. She's back on water skis, too.

Jane has absolutely no regrets about her decision to have the mastectomy and breast reconstruction. And she'll tell any woman who'll listen that her new breasts are better than the originals. "The original set didn't mean that much to me. But these breasts represent being cancer-free, and they help make me feel whole again."

Despite going through the anxious and traumatic ordeal of having breast cancer, Jane now focuses on the positive things that have come from her experience. Drawing on this, she's better able to counsel her patients who have breast cancer.

"I've walked in their shoes. I know what it feels like. It's so rewarding to be there for them and to reassure them. It's one of the greatest gifts from something horrible that came into my life."