Breast cancer has been on – and off – Pamela Hempstead’s mind since her mom died from the disease in 2000.

It was her mom’s diagnosis that prompted Hempstead, now 52, to get her first mammogram 20 years ago. Her baseline mammogram revealed she had a benign cyst. She had a lumpectomy to remove the cyst, and went on with her healthy lifestyle. The Huntersville, North Carolina resident is a fitness instructor who lifts weights, bikes, hikes and eats healthfully.

When her health insurance lapsed, she stopped getting regular mammograms. This January, she had enough hours through her part-time job at the YMCA to qualify for insurance under the Affordable Care Act. She scheduled that overdue screening.

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When she went for a mammogram in early February, it was suddenly déjà vu. She was called back for a biopsy and told to return in a couple of days for the results.

“I was so cavalier about it,” she said. “I was even a few minutes late for the appointment. I just knew they were going to tell me everything was fine. So, I was confused when someone told me a nurse had been looking for me. I was more confused when I was led into a conference room instead of an exam room.”

Vicki Davidson, nurse navigator, told her they’d found cancer: ductal carcinoma in situ (DCIS), stage 0. The cancer was confined to the milk ducts in her left breast. The news was a shock, but the prognosis was excellent.

Hempstead's breast surgeon laid out her options: a lumpectomy followed by radiation or a mastectomy. Hempstead thought of her late mom: “At the end of her life, she told me she wished she’d had a double mastectomy and never worried about breast cancer again.”

Hempstead didn’t want to consider radiation; she decided a mastectomy of the left breast was the better option.

Because of her family history, she chose to have a genetic test, which revealed she carried the BRCA1 gene mutation. That put her at increased risk for breast cancer and ovarian cancer. To lower her lifetime risk of future cancers, she chose to have a double mastectomy and a complete hysterectomy.

Reconstruction without implants

Dr. Blair Wormer

Just as she didn’t want radiation, she didn’t want breast implants, either. (“After 52 years of clean living, I did not want to introduce a toxin into my body,” she said.) Dr. Blair Wormer, a plastic surgeon with Novant Health Appel Plastic Surgery, offered her a new-to-Charlotte advanced form of surgery. Wormer could create new breasts using her own tissue from her abdomen. Deep inferior epigastric artery perforator (DIEP) flap surgery uses the tissue discarded during a tummy tuck to build new breasts at the same time you have a mastectomy.

“We have brought this option to the Novant Health system to advance breast cancer care and reconstruction,” Wormer said. “’Free flap’ surgeries like this are the most technically challenging and demanding operations plastic surgeons can perform and are only offered in a handful of centers in the state. Essentially, this is a transplant of the patient’s own abdominal skin and fat to their chest using a microscope to connect blood vessels 2 to 3 millimeters in size with sutures the size of a human hair.”

“It allows us to reconstruct breasts without the need for implants,” he said. “They are a great option for many patients, but they carry their own limitations as prosthetic devices. Additionally, patients gain the benefit of aesthetically contouring their abdomen with this surgery, which is one of the rare silver linings in a tremendous journey they embark on when battling cancer.”

“We hit it off instantly,” Hempstead said of her plastic surgeon. “I observed him and the way he carried himself and could see he paid attention to detail. I felt confident with him.”

COVID-19 got in the way of the complex surgery. Wormer told his patient the transplanted flap requires close post-surgical monitoring only available in the ICU – and ICU beds were being reserved for a potential influx of COVID-19 patients. Hempstead's doctors cleared her to wait, as most of her cancer had been removed in the biopsy.

To emotionally prepare for surgery, Hempstead joined a Facebook support group for women who were facing or had had mastectomies. A friend of hers – who counsels trauma survivors – encouraged her to write a love letter to her breasts. “I needed to grieve the upcoming loss,” Hempstead explained. “I allowed myself space to grieve this part of me I was losing.”

By June, she was ready for surgery, and Novant Health Presbyterian Medical Center was now ready for her.

Visualization helped her prepare, she said. She saw the process unfolding. She imagined herself in the OR. She asked for prayers for her doctors and her family. She repeated affirmations to herself: “My body is a place of peace.”

She allowed herself to feel … blessed. “I fell off the wagon with mammograms,” she said. “I went nine years without getting one and when cancer was discovered, it was Stage 0. That was by God’s grace.”

When she woke up from the full day of surgery, her brother and sister were in the room with her. “My loved ones woke me up,” she said. “I was so thankful.” Wormer came to see her in the hospital and told her she looked great. “He could see what I was going to look like,” Hempstead said. “All I saw were six drains, scars, stitches and tape.”

Her follow-up appointments have been with both Wormer and Alex Schuler, his physician assistant. “Alex and I formed a bond,” Hempstead said. “She is young and feisty. When I had my last drain removed – it had been causing so much pain – I told her I wanted it out in a hurry. I said, ‘Alex, I need you to be brief and confident.’ She told me: ‘I’m always brief and confident.’ We have a wonderful relationship. I couldn’t have chosen a better team.”

Three months post-surgery, Hempstead completed the second and final part of the journey – the hysterectomy.

It’s been quite a year for a woman who had let her annual mammograms fall by the wayside. But Hempstead considers it a good year. Her motto is “Living Out Loud 2020.” She wants people to know: “I have walked through the storm and had Jesus with me.”

She also has a message for women over 40: Get your mammogram.