Cancer patient lets photos tell story

She was gliding a bar of Dove soap under her right arm when her fingers skated over what felt like a marble near her armpit.

It was breast cancer.

Debbie Horwitz was 32.

She chose to remove both breasts, a double mastectomy, even though the doctor said he could scoop out the lump. When Debbie was 9, her mother died of breast cancer. Her grandmother had it, too. Newly engaged, she would not flirt with chance.

Like most women who have mastectomies, she was determined to rebuild her body, to reclaim her curves. She would reconstruct her breasts and slip, princesslike, into her mother's retooled wedding dress with its clingy, creamy silk bodice.

She couldn't believe it when the plastic surgeon told her there were no pictures of what women her age could expect from the process. The pictures would show women in their 60s and 70s, who are far more likely to get breast cancer. Young women have more elasticity in their skin, he told her. Her results would be completely different.

A friend tried to take her mind off the tumult. Before the mastectomy, she booked Horwitz an appointment to have her engagement portrait taken.

She figured Horwitz, a child advocacy specialist with the N.C. Department of Administration, could primp and pose and feel pretty in the midst of her despair.

The timing was also practical. Horwitz knew that chemotherapy would steal her hair; at least she could sit for pictures before it fell out.

She met her photographer, Missy McLamb, at the Raleigh Rose Garden on a simmering June morning in 2004. The thorny bushes wore voluptuous, velvety blooms. Horwitz wore a green and white tube top, the kind that accentuates the chest. McLamb took note of that.

As McLamb snapped the shutter, Horwitz shared her story. Afterward, in the parking lot, McLamb made a casual offer: If you want, if you think it would help you heal, I can chronicle the process.

Horwitz's face revealed nothing, but she thought it was an outrageous suggestion. No way could she stand topless in front of a camera. That night, she told Evan, her fiance, about it. Isn't that weird?

But she couldn't stop considering the possibilities. You know, she told him, pictures don't exist. Maybe it could help other women like me.

OK, she told McLamb. Let's do it.

A week later, on June 27, Horwitz finally let herself weep for what was and what was about to be.

The next morning, a doctor sheared Horwitz's breasts from her chest.

Horwitz felt the blow at the core of her femininity, and she was scared. She was desperate to know how she would look each step of the way as a surgeon sculpted breasts where only flaps of pearly scar tissue remained. These new breasts would literally recast her body image. She'd need new bras, new tops to conform to her unfamiliar silhouette. But she had no idea what that would look like.

A tough first shoot

Her body would get a few months to heal before a surgeon would begin the type of reconstruction Horwitz chose -- delayed tissue expansion. Tissue expanders -- Horwitz calls them water balloons -- would be inserted beneath the skin and slowly inflated over many weeks, her skin stretching painfully to accommodate them. A nipple would be fashioned, then tattooed with pigment.

But first, as planned, McLamb showed up at Horwitz's North Raleigh home in August to take the first picture. McLamb doesn't do well with gore. She was nervous about how she'd cope with Horwitz's body, still etched pink with fresh scars.

McLamb walked through the door and heard Horwitz shout: Tell her to go away!