Byline: JANE SIMON
AS Karen Bernard stepped out of the sea, she could feel all the fear and anxiety of the last three years washing off her.
A natural extrovert, she had gone topless on the beach many times before - but this time was different.
In June 2001, at the age of 38, Karen found out she had breast cancer and underwent a double mastectomy and breast reconstruction.
The diagnosis had come just five months after she separated from her husband of 14 years.
But, incredibly, instead of buckling under the stress, Karen describes having cancer as "a great experience".
And to help other women, she kept a photo diary of every stage of her treatment - to the amusement of family and friends who have been ordered to take topless photos of her everywhere from Blenheim Palace to the Grand Canyon.
Now at her home in Hertfordshire, as Karen talks about publishing her photos in a book, it's impossible not to be impressed by the positivity she radiates.
"Breast cancer was obviously a lesson sent for me to learn something from," she says. "Before my operation I asked if there were other women I could meet who'd had reconstructions or any pictures I could see.
"I was told I wouldn't want to see them. But I did. My doctor said other women might not be as relaxed about taking their tops off as I am.
"Since my surgery, I've shown my new breasts to a few women who've just been diagnosed with breast cancer and they say I've taken the fear factor out of it."
October is breast cancer awareness month, but Karen, 41, believes it's not women who need to be made more aware of the disease but doctors.
"I was told twice by the first cancer specialist I saw that I was too young to have breast cancer and too young to have the mammogram I asked for. If I'd listened to him, I could be dead now."
Ten years earlier, Karen's mother had breast cancer and since then Karen checked her breasts regularly. When her symptoms appeared literally overnight, the timing couldn't have been crueller.
"For the first time since my marriage ended I'd had a really blinding night out with friends," Karen recalls. "And then I woke up in the night, stretched, and found the lump in my right breast.
"My GP referred me to a cancer specialist who insisted I was just being over-anxious. He said, 'If you get fed up with the lump and it annoys you, come back in six months' time and I'll whip it out.' Those were his actual words.
"Fortunately for me, my mother made me an appointment to see her specialist at St John and Elizabeth Hospital the very next day. He took a core biopsy on the spot and four days later he confirmed I had breast cancer."
Because Karen had small breasts, there was a risk the cancer had spread to the ducts as well, and she was told a mastectomy was the only option.
"I didn't want to feel lopsided, so I said, 'Fine, I'll have a double mastectomy'. Then I left the room to get my head round it, leaving my mother and the doctor stunned."
Karen is a practising Buddhist and believes that chanting helped her keep a positive attitude. "I'd seen my mother get through cancer and be incredibly brave and that gave me strength. And I knew I had to be strong for my children, who'd been through a lot."
At the time James was 12 and Victoria was 11, and faced the additional worry of knowing that this type of cancer was hereditary.
Because she was young and fit, doctors told Karen she would be an ideal candidate for reconstruction.
"I told my plastic surgeon: 'I'm a single girl - it's very important that I look normal, can you save my nipples?' But they couldn't because the cancer could have gone into them too." The operation lasted seven hours.
"When I came round I remember seeing for the first time that I had a cleavage," Karen recalls. "I thought it must be the morphine.
"I'd also been told that after a mastectomy I wouldn't be able to lift my arms above my head, so I asked for my hairbrush and brushed my hair. I was determined not to be ill.
"Every day I'd get dressed in jeans and a little vest top, put on some make-up and go sit in the hospital garden.
"I'd had implants of silicone and saline and over the next few months they'd inject me with more saline to gradually pump me up through two valves under the skin on each side.
"At first I didn't heal well. My skin went black and there was a chance they'd have to take out the implants.
"But I think I frightened the doctors with how positive I was. Before I was discharged, a nurse asked me if I'd looked at myself yet.
"She took my bandages off and made me look in the mirror. That was the first time it was really scary. I looked like I'd been in a car crash.
"But the best thing was when my friend Mandy came to visit after I'd come out of hospital. I was having _ a bath and warned her it was a bit gory, but she said: 'Oh my god, those are the best boobs I've ever seen!' It was exactly what I needed to hear.
"Since then I've shown them to most people I know and even people I don't.
But there was still the issue of nipples. "At first I was issued with stick-on nipples but they don't stick very well and I was always worried about one falling off. I've since found a wonderful tattoo artist who tattoos my nipples on for me. They keep fading so I've had it done three times, but he refuses to take any money for it."
Karen's lymph nodes weren't affected so she didn't need chemotherapy.
But because the type of cancer both she and her mother suffered was oestrogen receptive, she later had her ovaries removed as a precaution. "I was more angry having my ovaries taken away than my breasts," Karen admits.
"I wondered if anyone would ever see me as a woman again. But they have and I have had boyfriends since then.
"Once when I was seeing someone, I went to my plastic surgeon for my regular saline top-up and told him: 'I've got a big weekend, so I'd really like a good pair.'
"Then I went to Tesco's and as I was leaning over the vegetable counter I knocked this poor woman in the face. She looked stunned being whacked with this great big bosom. So I had to have some saline drained because they were lethal weapons.
"I used to be a 34B and now I'm a 36C. I'm very comfortable with my body so I think that helps other people not be so frightened of it either."
But it wasn't until this August on the Greek island of Zante that Karen felt brave enough to go topless again.
"I was in Greece with girlfriends and I was happy to take off my top while I was sunbathing lying down but I'd put it on to go swimming. Then I realised: I am me and people might look at me and stare, but they might look at me and think, she's got courage. I whipped off my bikini top and swam in the sea for the first time since I got cancer.
"I felt incredibly liberated. It was the end of one chapter and the start of the rest of my life.
"I really believe that cancer was a challenge I had to get over to progress with my life. It made me grow up and realise you have to grab life with both hands.
"My ex-husband, Geoff, and I used to have our own business as mortgage brokers. We're still good friends and continued working together.
"But I realised I didn't want to sit in an office any more, so I qualified to do massage, Reiki and Indian head massage. Now I'd like to offer them in cancer clinics."
And in a fairytale postscript to her story, Karen has fallen in love with a man who lives in France.
"After cancer, I felt pretty emotionless, so to have all these emotions turned on again, to feel this wanted, this loved, after all that's happened is too amazing for words."
To make a donation to Cancerkin, call 020 7830 2323.
BLESSING: Aged one with mum and dad; Karen in her garden in 2001 before the diagnosis; Soaking up the sun on a barge in September 2002; Flashing more than a smile, Grand Canyon, April 2002; Confidence in the Caribbean. A holiday in Jamaica, 2003; FACING THINGS: Karen in hospital; FULL OF LIFE: Karen offers a positive message
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