Before cancer, my friend Diane had the kind of alpha breasts that men ogle and women envy. She tells the story of a baby shower 20 years ago, right after her mastectomy. Most women tried to comfort her and said, "Oh, you look great."

But one ornery friend from college said, "It must be really hard for you, because you always had such great breasts. All the men stared at you."

Diane said, "Well, not anymore."

In our breast-obsessed culture, one in eight women face disfiguring and life-threatening breast disease.

In my circle of friends, many have taken the hit. Debby, 56, an educator at the University of New Mexico, is celebrating her one-year anniversary of being cancer free. Barbara, 61, an artist's agent in Seattle, was diagnosed with breast cancer in 2003. She survived. But in 2005, the cancer reoccurred in her lower lumbar and thoracic spine and marrow. She now lives with metastatic breast cancer.

Lea, 76, a United Church of Christ pastor in Omaha, Neb., is a seven-year survivor of breast cancer. At the same time that Lea was in cancer treatment, so was her daughter Laurie, as well as my friend Jane, who works at the PBS station in Lincoln.

A year ago, my friend Susan, a local artist and photographer, passed away after being treated for three years for the same form of breast cancer that Diane had.

It's a surreal landscape, with a huge price for individuals, incalculable costs to our cultural fabric and soaring profits for makers of cancer drugs.

When women see the beauty and symmetry of our breasts as a center of our powers of motherhood and seduction, how do we redefine "the center" when symmetry is damaged, and the breast is no more?

In 1986, my friend Diane Hosey, then 31, worked as a front desk supervisor at a Dallas hotel. "I was very career-minded and set my sights on what I wanted to do and how I was going to do it," she said. She had recently broken up with a man she'd been seeing.

Since July 1986, she'd felt tenderness in her left breast and was having vivid, frightening nightmares. She resisted going to the doctor. When she did, she was misdiagnosed. The doctor assured her that she had fibro-cystic breast disease and was too young to have cancer. Diane was told to cut down on caffeine and take Vitamin E.

By February 1987, her left breast was inflamed, hot to the touch, and physically larger than her right breast. The same doctor was now alarmed and told her to see a breast specialist. It took a week to get in to see one of the two female breast surgeons in Dallas at that time. Diane recalls: "I went in to see [one of the surgeons] and she immediately knew. It was in her face, and that's when it hit me to my core that something was bad.

"Things started happening fast. I felt like I had lost control of myself. It was all very confusing, and I was scared. I had no idea what I was in for. Emotion-wise, I can't recall a whole lot but fear."

Diane was diagnosed with Stage 3 Inflammatory Breast Cancer, a ductile inflammatory carcinoma. The tumor over her heart was about the size of an orange. Stage 4 cancer is terminal. With the Stage 3 diagnosis, Diane was given five to 10 years to live.

Before friends could give Diane the "you're going to beat this" speech, Diane had already told them: "This is not going to take me down. I'm certainly going to live beyond 40 years old. I've got a lot to do."

It was 20 years ago, and chemotherapy was brutal. The doctors said, "We're going to give you as much as you can take without killing you."

Diane was afraid of the very real suffering that was ahead. She feared because she didn't have a spouse or partner to take care of her. She was afraid that if she were to die, she'd die alone.

She's still here, and like other cancer survivors, she took it all. She endured the humiliations of vomiting and diarrhea in front of friends who cared for her in her home. She now laughs about the disorienting confusion of being lost and stoned in Baylor Hospital, high on medical marijuana.

She suffered through the battery acid of eight chemo cocktail treatments that knocked her so flat that she required hospitalization. Her breast was amputated. She had radiation treatments. She made it through a fearsome night when her fever spiked and all she could say to herself was "fight it, fight it, fight it." Indignity piled upon indignity. Back then, frozen blue swimming caps were put on the heads of chemo patients in the belief that it would stop hair loss. It didn't work.

She fought with the full arsenal of everything available to her – modern medicine, trust in her doctor, medical pot, family and friends, meditation and visualization.

One year after her diagnosis, Diane was cancer-free. Still, there were so many uninvited, unwanted changes. The "poison, slash and burn" of cancer treatments left her body marked up, carved up and sewn up. She now had a firsthand acquaintance with death. Future intimacy was a question mark. The chemotherapy left Diane unable to bear children.

"Scarification and other forms of body decoration were traditionally considered marks of civilization. They distinguished the civilized, socialized human body from the body in its natural state and from animals."

Susan Mullin Vogel, African Aesthetics, 1986

When my eyes see a breast or a scar, intricate responses crackle in my mind. It's a stream of consciousness story with narrative threads of Mommy, first touches, approving looks in the mirror, despairing looks in the mirror, scarred faces in old Western movies, Scar in The Lion King , and "street cred." When a woman in another culture checks out a breast or a scar, she may have a whole different set of responses.

For centuries, many indigenous cultures in Africa, such as the Nuba, have been connoisseurs of scarification. These "beauty operations" are both ornamental and functional. Scars are proof of courage and evidence that one can endure pain without complaint. They represent stages of maturity, how many children a woman has borne or family lineage. They are regarded as appealing and erotic to touch. In some tribes, a scarified woman is seen as sexually demanding and therefore sought after.

In ancient India, warriors proudly showed their scars – if they were on the front of their body. Frontal scars were the mark of a fierce survival of battle. Scars from a weapon strike on one's back were a source of shame, because they signaled flight.

It's different here. When a woman in the United States willingly goes under the knife, it's more likely that she asks for scars to be hidden or minimized.

In our popular culture, scars often signal a sinister character. In Disney's The Lion King, the lion Scar is merciless, calculating and cruel. In the movie The Craft, Neve Campbell's character is ostracized because of burn scars on her back. Even in a publication that is intended to support breast cancer survivors, the first line in a recent article about scarring begins, "An ugly, visible scar ..."

When we enter the subject of breasts, well, get ready. Carve out a big chunk of time.

First, there was mom, and our infant familiarity with the breast has staying power. Studies have shown that even for heterosexual women, images of breasts are more arousing than images of male erotic nudes. Women from Lady Godiva to Sojourner Truth to protesting feminists in the 1960s bared their breasts in public as a political means to put men on guard and bring time to a standstill. Domes in architecture re-create the "sacred bull's-eye," reminding us of our original contentment.

Diane describes her life after cancer treatment as a collage in progress. Her breasts, her thoughts about being a mother, her career, her sexuality were all deconstructed and then patched back together.

From reconstructive surgery, Diane has two 6-inch scars on her left breast mound, a 6-inch scar on her right breast (which had to be reduced in size to match the left,) a 12-inch scar along the bikini line on her stomach (where muscle and tissue were removed to make her new breast mound), and a 4-inch scar on her inner thigh (where skin was removed to form a new nipple).

She has sometimes felt like the character Sally in Tim Burton's The Nightmare Before Christmas. Sally's body parts are sewn together with visible, black stitches.

In 1988, shortly after her one-year anniversary of being cancer-free, she became involved with a man. She knew they weren't suited for each other for the long run. But "he brought me back to life as a woman," she said. "There's just no two ways about it. It did not bother him in the least that I did not have a breast. He saw me as beautiful. He told me I was beautiful."

That relationship ended, but as the next step of her healing, Diane wanted reconstructive surgery.

"Reconstruction is different than plastic surgery or cosmetic surgery because of the fact that mastectomy is an amputation," she said. "When you put symmetry back into your body, not only ... do you look into the mirror and see a shape again when your clothes are off, but there's a psychological healing process to that. It's not that I tried to change what God has given me or embalm it or stay youthful, but it's part of the healing process. I wanted to feel more whole."

Of course, the other scars – the unmarked, hidden ones – have also lingered for 20 years. There is no feeling of stimulation in the reconstructed breast. She questions why relationships with men haven't lasted.

A therapist suggested that she was protecting herself from rejection and that, rather than building a relationship slowly and carefully, she wanted to challenge men to look at her, to see her as she now is and to realize what she has gone through.

After a hysterectomy in 2001, Diane found herself wondering: "Why am I cutting away my femininity? Some part of me wanted to stop cutting away."

When you lose all sense of self

The bonds of a thousand chains will vanish.

Lose yourself completely,

Return to the root of the root

of your own soul.

By Jalaluddin Rumi, excerpted from We Can See the Truth in Your Eyes , translation by Jonathan Star

In 2007, Diane Hosey, at age 52, celebrated 20 years as a breast cancer survivor. She has her own company, Numina Consulting, and does corporate training and development.

Now, cancer is talked about openly, and celebrations of survival are giddy, poignant affairs. During a recent breast cancer walk, a pickup decorated with a gigantic, 8-foot bra drove up and down my street. Cheerleaders in the truck whooped and hollered and contributed to an all-around party atmosphere.

For the Komen Race for the Cure in October, Diane invited friends to join her team. We spent the night before the walk exuberantly decorating our team hats with every pink doo-hickey we could find.

Diane's healing is ongoing. It's been a long path, and along the way, there have been light-bulb moments. She describes one. As she was writing the words "Scared" and "Scarred" in her journal, the letters shifted and the spelling didn't look quite right. She realized that she'd spelled "Sacred."

As a step towards reconciliation with her body, she agreed to work with me on this story about the scars from cancer. "Full womanhood comes from within you and from leaning into all of that," she said. "Not moving away from it. Not shelving it. Not covering it up. I don't feel bad about the insecurities or the narcissism about looks. But it is a bondage and it holds us back in so many ways."

"The answer lies in tapping into spirit, getting to that tap root. Because it feels very cut off. You go through breast cancer, and then you pick up a Vogue or any other fashion magazine, and all you see are breasts, beautiful breasts, on beautiful bodies."

In September, I traveled to New York City with Diane and Nancy Rebal, another friend. The three of us stayed in the same hotel room, and I learned that Diane feels way more freedom about prancing around naked in a room than I do. Nancy looked at me and laughed, "She always does that."

Four years ago, Diane entered into a serious relationship with a man that lasted two years. She asked him, "What do you see when you look at these scars?" He pointed to one and said, "I see a band of jewels."

Right answer. Diane says that this was the first relationship, before or after cancer, where she allowed herself to be open and vulnerable – emotionally and sexually.

She posed the same question to me. "What do you see when you look at my scars?" Short answer: I see street cred – she won the fight and lived to tell about it. Shallow answer: I'm a little bit jealous. Diane is long and lanky, and she looks great. The scars are interesting.

She's asking me to go deeper. I think. When I move into another way of seeing, I see the scars as the battle remnants of a new warrior class. I see the scars as marks of courage and a ferocious will to live.

They are the shrine of who she used to be and an entry point for God.

Karen Blessen is a Dallas artist and freelance writer. Her e-mail address is kblessen@sbcglobal.net.