Home About the Doctor Contact the Doctor Map and Location Procedures Breast Body Face Hand/Microsurgery Breast Reconstruction Photo Gallery	Rebuilding Helen After surviving breast cancer and a divorce, Helen Higby decides it's time to reconstruct not just her breasts but also her self-image Author: Gina Kim Bee Staff Writer The country roads from Yuba City give way to Interstate 80, the Bay Bridge, then San Francisco, where on Monday, Helen Higby will wake up in a hospital bed with two size-B breasts. They'll be different from the ones cancer took more than a dozen years ago -- they'll be smaller, firmer and encircled with scars. And they will give the 63-year-old from Yuba City something she feels she is missing. "I think it's going to be the rearranging of my body -- and it'll be more of a return to what it was before I had the cancer diagnosis," she says. "I don't know if it's a magical-thinking sort of thing. I don't expect to be skinny and 20 years old again. But I hope it'll feel like the old me." Helen is reinventing herself. She hasn't cared much about her appearance since cancer and career got in the way. Her petite frame carries 25 extra pounds, her hair never thickened after chemo- therapy, and her thin lips extend into a maze of worry lines. For the past decade, Helen has worn a bra lined with prosthetic breasts whenever she needs to look her best -- holidays, weddings, teaching in nurse practitioner programs. The weight of the ! prostheses, the straps cutting into her shoulders and the strain on her neck, keep her from wearing the bra much beyond that. She avoids mirrors when she can and dreads shopping, especially those three-fold mirrors in dressing rooms. That's when she can see her body from every angle, the growing waistline, the sunken chest. Now, after retirement, divorce and the death of her mother, she is rebuilding her body, her life and her future. A transformation It's still dark when Helen travels the mile and a half from her daughter's Twin Peaks apartment to the Davies campus of the California Pacific Medical Center in San Francisco. She has to check into the hospital at 6 a.m. to prep for the more than eight-hour surgery. "What am I doing this for?" she remembers thinking. "I got past this thing that was life-threatening. I'm healthy. Why am I putting myself at risk of something bad happening?" She recalls the dream she had a few months ago, when ! her new breasts turned into two black blobs because her transplanted t issue wouldn't take. As the anesthesia kicks in, the anxiety floats away. She will have a figure once more and no longer feel compelled to hunch over, hiding her concave chest. Helen eschewed breast reconstruction back when defying death was more important than what she looked like. But life unravels unexpectedly. Helen's self-image was shattered by a breakup and her retirement from teaching in nurse practitioner programs at the University of California, San Francisco, and Sonoma State University in Rohnert Park. Helen decided to kick-start her life with a new body -- new breasts and a tummy tuck, all rolled into one surgery -- and she found herself in the San Francisco office of Dr. Gabriel Kind. Kind specializes in molding breasts from belly skin and fat. The plastic surgeon practices the deep inferior epigastric perforator, or DIEP, flap technique, which, unlike other breast- reconstruction surgeries, preserves the stomach muscles and leads to a qu! icker recovery, sometimes by months. "There is a feminine shape that breasts are a part of -- our feminine curves. That's part of our being women," Helen says. "They don't have to be big or anything like that. It's just that shape, and I miss it." The cost Helen's grandson is staring at her chest with curiosity. "He was always very intrigued when I had no chest," says Helen of the third-grader. "Now, he knows I had the surgery." During the late-October operation, the doctor took a football-shaped piece of Helen's lower abdomen -- the skin and fat, cut it in half -- and made them into breasts. He had to slice through a bit of her rib cage and he stored those rib pieces in her lower belly, little nubs beneath the skin, so he could construct nipples out of them during a future surgery. It's been a couple of weeks since the surgery, and Helen's entire body feels sore, as if she was run over by a big rig. She can't remember exactly what she ju! st watched on television, what the beginning of her last thought was. It could be the Tylenol with codeine, maybe residual effects of the morphine drip or anesthesia. Helen has a raw, arcing surgical wound across her lower belly that goes from one hip to another. Each of her new breasts is orbited by stitches. There are several drains collecting the excess liquid from her fresh incisions, still far from becoming healed scars. But she's already planning her new self -- she'll join Curves fitness center and go on Weight Watchers, just as soon as she feels better. "I'm tired and moving around like I'm a hundred years old," she says. "But it doesn't matter. At least I'll be a woman again." The road to reconstruction It's been a month and a half since the surgery and Helen is standing in Kind's office, her gown open. The deep-red lines around her breasts and across her belly are healing. One breast feels a little stiffer than the other, and both are smaller than she anticipated. She bought two C-cup bras before the sur! gery, but her new breasts better fill B cups. "I like the size, I'm fine with the size," she tells Kind. Plus, her new breasts don't hang down like her original 34-D ones did. "I won't have to worry about droops," she says, giddy. Helen hadn't bought a bra in more than a decade. She still remembers that Valentine's Day in 1992 when her hold on life became tenuous, her breasts a potential death sentence. That day Helen focused on the doctor's strained face for hints of the news to come: The biopsy showed the mass in her left breast was lobular carcinoma. She had an 80 percent chance of dying in the next four years. "Now I'm a statistic," she recalls thinking. "I have cancer." Two weeks later, the surgeon removed a 11.1-by-5-centimeter cancerous mass intertwined with tissue, the size of a Twinkie, and Helen's left breast. She did everything the doctor suggested: regular chemotherapy and also an experimental treatment of high-dos! e chemo followed by a transplant of her own bone marrow. Then came a r ound of radiation therapy. "I said, 'Yes, yes, yes,' " Helen remembers. "It's kind of like going after a mosquito with an atomic bomb, but I was going for anything that might work." Two years later, Helen had her right breast removed. It was cancer-free, but having had lobular carcinoma meant there was a good chance cancer would appear there too. Breast reconstruction wasn't even part of the conversation. "I knew at the time of the biopsy that it wasn't good," she says. "I just wanted it off. ... I didn't want to have anything put back together because I wasn't sure I was going to be alive." Finding a home Helen is stripping wallpaper and painting. There's a home-improvement deadline now that Helen needs to sell her house. She hasn't been to Curves in weeks, the treadmill stands untouched. She has had no time to think about her new body because it's all about the house right now, the second one she thought she'd grow old in. He! len had figured out the finances of retirement, but she must have miscalculated. As she pictures the "for sale" sign going up, she thinks about where life has taken her. It was Aug. 11, 2003, when her 17-year marriage ended. Perhaps there were signs she should have noticed -- but Helen was too wrapped up in caring for her mother to give it much thought. To her, it came without warning or notice, like a storm erupting on a clear day. Helen's mother had moved into Helen and her husband's Bodega Bay home with them a year earlier, when emphysema left her mother needing full-time care. Helen, who had just earned her doctorate in nursing and gerontology from UCSF, retired from teaching to help. Then came the breakup, a move to Yuba City, and three months later, the death of Helen's mother. For the first time Helen could remember, there was no one who depended on her, no one to care for. Whom did she matter to? Did her life have purpose anymore? Would! anyone find her attractive again? Depression began to consume h er, the couch became her sanctuary. The anti-depressant Lexapro might have saved her life. Her self-discovery began when she bought the Yuba City house in 2004, signed up for breast reconstruction and enrolled in Weight Watchers and Curves. But now the bills are stacking up. She dreams of traveling, but to travel, she needs money. "The house I'm in is financially a little more than I want to maintain," she says. "In the last two, three, four months, I understand the financial situation of being retired and I just realized the house is more than I want to put my money into." And Helen, the reconstructed Helen, takes a step backward. A rebirth With her silver Yorkshire terrier riding shotgun, Helen drives her gold Honda CRV home from Arizona, west on Interstate 40 and north on Interstate 5. "It's the first time in my whole life I've ever gone anywhere by myself," she says. It's February and financial wizardry meant Helen didn't ! have to sell her house after all. Refinancing allows her to travel, and right now, she's returning from a time share in Sedona where she spent five days, her dog keeping her company. She drove around the Southwestern terrain, saw red rocks and shopped. But she packed lunches instead of eating alone in restaurants, and didn't hike much. She still needs to get into shape. "Sadly, I haven't gotten back into exercising and losing weight like I'd been wanting to," she says. "I just find I'm not terribly motivated." Helen is figuring out who she is, not as a wife, mother or daughter, but as an individual. And reinvention comes with spurts of success. She's joined a church, signed up for the choir. She's going to be walking in a 24-hour relay for the American Cancer Society, the first half-hour dedicated to cancer survivors. And she sits on the board of directors for the local Habitat for Humanity, volunteers for a consortium for the homeless, and is on the! board of a food bank. Plus, she's headed to the Caribbean islan d of St. Maarten with an old girlfriend from college, two divorcees sipping fancy drinks and boating around the warm islands -- the way she imagines retirement is supposed to be. But there's still one more step she must take, one last surgery to complete her transformation. The final touch With a purple pen and a tape measure, Kind is marking Helen's breasts -- there should be more of a curve here and the nipples should go there. It's been a full year since the initial surgery and now she is back in the hospital for a final sculpting and the construction of her nipples. While most patients finish the process much earlier, Helen waited until she was ready. Helen just celebrated her 64th birthday. She took two of her grandchildren to Lake Tahoe and the first stop was a market where she bought a cheesecake, birthday hats, a couple of noisemakers, and a microwaveable breakfast of scrambled eggs and sausage. "They asked what that was for and I ! told them, 'It's my birthday and you're going to make me breakfast,' " she recalls. She knew what she wanted and she got what she asked for -- breakfast in bed. In the operating room, Kind reopens Helen's abdomen scar and retrieves the bits of cartilage he left there. He cuts and sews her right breast so it sits up the way it's supposed to. And then he makes small slices where her nipples will be, inserts the cartilage he and his assistant carved into rivets and sews the skin together. Soon after the two-hour surgery, Helen is perched up in her hospital bed. Peeking out from beneath her green-striped gown with blue flowers are the orange traces of Betadine that was painted across her chest. Helen still plans to lose weight. She wants to get into good-enough shape to go on a walking tour of England's Lake District in the spring. But her physical transformation is no longer as important as the one that has happened within. "Maybe my body isn't w! here I want it to be, but I'm happier with my life," she says. "I feel different." She didn't become like the heroines of the Georgette Heyer books she likes to read again and again -- the ones who always seem to find husbands even in the most formidable circumstances. It might not be a storybook ending for Helen, but for her, that's OK. "Now, I don't mind looking in the mirror, I don't mind focusing on myself, I don't mind seeing myself," she says. "I have a greater appreciation for who I am." The Bee's Gina Kim can be reached at (916) 321-1228 or gkim@sacbee.com. About this story: Reporter Gina Kim and photographer Autumn Cruz have followed Helen Higby since her initial breast-reconstruction surgery in October 2005. They attended doctor visits and witnessed her final surgery earlier this month. Caption: Sacramento Bee photographs / Autumn Cruz Helen tries on pants at Macy's on Nov. 9, 2005, the first time she has shopped since breast reconstruction surgery the month before. "It has been years since I have been comfortable coming in the dressing room seeing my body," she said. "It's a different experience and I'm really enjoying it. It makes up for any discomfort I might have and then some." In October 2005, at age 63, Helen decides she wants "to be a woman again" with breast reconstruction. Nurse Kerry Canellos, above, plaes a dressing on Helen following Helen's final breast-reconstruction procedure Nov. 1, 2006, at California Pacific Medical Center in San Francisco. Below, Helen guides her grandchildren to a pony ride during a trip with her daughters and their kids to Apple Hill in November 2005. Helen waits to be photographed by Dr. Gabriel Kind on Dec. 6, 2005. Kind, who performed Helen's reconstructive procedures, records patient progress with before-and-after images. Copyright 2006 The Sacramento Bee Record Number: SAC_0405115913