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Here we were, the four of us, right back in Dr. Grange's examination room.  I'd always known we'd be seeing Dr. Grange again.  Only this time, Terri came along to offer us moral support.

She looked so good three weeks after her double mastectomy.  Refusing to wear the falsies the hospital sent home with her, she opted instead for lean and breastless and looked like a slim adolescent girl ready for a good game of kickball out on the playground.  She had just started her reconstructive surgery , and her oncologist would shortly start her on Tamoxifen, a medication that would help to reduce her chances of ever getting breast cancer again to practically nil.

But Deb, only days before, had undergone a stereotactic biopsy for two suspicious areas that had turned up on her mammogram and MRI.  The results had come back as atypical lobular hyperplasia, a pre-cancerous condition.  Mary's MRI had also revealed a suspicious finding, and suddenly, we knew breast cancer was a stark reality for all of us.

Deb called for an appointment, and now Dr. Grange was describing options for treating her hyperplasia.  "Your situation is a bit complicated," Dr. Grange carefully explained, and talked at some length before Deb politely interrupted her.

"I would really like to have a double mastectomy," she said quickly.

Dr. Grange threw back her head.  "Thank God!" she exclaimed.  Dr. Grange never recommended a mastectomy herself, but she was obviously glad Deb had come to the decision on her own.

"Now," Mary suddenly cleared her throat, "here's the thing."

Terri snorted.  Whenever Mary started any sentence with, "Now, here's the thing," we could expect some kind of bomb shell to drop from her mouth.  Mary, who had grown up as our shy little shrinking violet, had a way of making people's jaws drop now that she was a self-assured adult.

"I want a double mastectomy, too," she said without any preamble.

Dr. Grange gasped in amazement.  "Oh, my God!"

I figured I might as well make her day.  "I'm thinking I might choose that route, too," I said.

Dr. Grange threw her hands up in the air.  "Oh, my God!" she said again.

I have to confess, I was really hoping she'd talk us all out of it.  Maybe she'd know of medication that would save us from breast cancer without the radical sacrifice of our breasts.  "Is this a crazy idea?" I asked her.

"No," she said firmly.  "Even though Terri hasn't tested positive for the breast cancer gene, there's something going on in your family." 

Scientists had only been able to identify two breast cancer genes, she explained, but suspected there were many other hereditary genes.  Mom and her grandmother had died in their  40's, Terri and Deb had been diagnosed in their 40's, and as a result, the risk was rising steadily for the rest of us with each newly infected family member. 

We could hope to catch it early or head it off at the pass. 

Before we left Dr. Grange's office, we knew we'd go full boor and finally try to put this thing behind us forever.

The next stop, a couple of weeks later, was at the office of Dr. Marie Montag, Terri's plastic surgeon.  Erin, the energetic p.a., showed us all the different implant options and even allowed us to observe as she injected Terri with a saline "fill".  When Terri's chest expanders, inserted during her mastectomy, were eventually filled to Terri's liking, she would undergo one final surgery to replace the expanders with implants.  Artificial nipples would be an option down the road.  The fill took half a minute, if that, and then Dr. Montag's assistants filed Deb, Mary and me into separate examination rooms to measure us and take pictures of our breasts for insurance purposes.

"Did you smile for your picture?" Deb asked me later.  I had, actually, from force of habit, but then remembered to stop myself.  It felt too ridiculous.

"I smiled," Mary said calmly.  "Why not?"

Dr. Montag said it would take six to eight weeks for our insurance companies to authorize the surgery but that Deb should be able to go a little sooner due to her hyperplasia.

We felt suddenly deflated.  Any hopes of getting it all behind us quickly evaporated.  But at least Deb would be first.

And hopefully, we were all in time.