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"We'll do another round of chemo," Oratz said.

"What are the other options?" Ken asked.

"There aren't any," Oratz said. "This is what we're going to do."

"What if Valerie decides not to?"

Oratz looked at Valerie. "She won't."

Valerie scheduled another port implantation and, for weeks after the mastectomy, carried around the grenade-shaped drains that attached to the tubes protruding from her dual incisions, which Ken emptied into the toilet as the sacs filled with lymphatic fluid. When the bandages came off, the nipple that remained was lower than before, and pale from reduced blood flow. The scars on her chest and armpit were thick, ropey knots, puckering her skin. She barely recognized her body.

She needed symmetry. She needed things to be as they should. She needed, after two years of surrendering to the opinions of doctors and the input of the cancer Web sites Ken pored over after every appointment, to have an ounce of control over her body. She saw a plastic surgeon, who implanted tissue expanders beneath her pectoralis major, the fan-shaped muscle connected to the breastbone. The tissue expander attached to a port beneath the skin, into which saline solution was injected every few weeks. Once the fluid-filled expanders had adequately stretched the skin, they would be swapped out for breast implants. No one—not even Ken—was allowed in the room when the doctor produced the syringe of saline. Its three-inch needle was notorious for making people faint.

The expanders made Valerie feel like there was a cinder block on her chest. The chemo made it impossible to think or stay awake. "I would sleep all day," she says. "I'd pick up a Q-tip and stare at it like, What do I do with this?" One day, with 40 minutes to fill before a lunch date, she sat down with a cup of tea. "The next thing I knew, it was 3 o'clock and the tea was ice cold." She'd passed out at her kitchen table. Another day, as she and Ken returned to their apartment after running errands, she saw an e-mail on her phone. It was from the other Ken. Sheila had died.

In April 2010, when Valerie had her final dose of chemo, Oratz's team threw handfuls of confetti in the air, but she couldn't bring herself to celebrate.

In May the tissue expanders were replaced with implants, which made her chest feel perpetually constricted; at night, she'd wake up thinking, I have to take this bra off. She wasn't wearing one—it was just her chest muscle pressing against her implants. There was no end to the discomfort, the inconvenience, the adjustments being made to the body she'd been left with.

Except, one day, there was. Gardening on a Saturday in June 2010, Valerie realized she'd been working for hours. She wasn't fatigued. She could focus. "I just felt like, I'm back!" she says. She started riding her bike. She lost 22 pounds in nine weeks. She slept. Ken wanted to buy her a piece of jewelry to commemorate her remission, but she chose to design her own—a gold ring with a constellation of stones, one of them bright pink. Sometimes she thought about Sheila. When she felt the too-tight-bra feeling, she told herself, You feel this because you're alive.

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