After racing across town on a cold, gray, rainy, and typically miserable New York City December day in 2001, I hung up my wet coat and took a seat in the waiting room. I was wearing a red velvet, white fur-trimmed skating outfit, because before hosting our company’s annual Christmas party, Mrs. Claus had to see a doctor about a biopsy.

My doctor was a real Marcus Welby type. He was old with stiff, white Brylcreemed hair and he always smelled like lozenges. I had been seeing him for years and loved and trusted him. But today it felt as if he was keeping me waiting for hours. Finally, he came into the examination room holding a clipboard and a bunch of papers, which I assumed were the results of my test. He held them up and without making any small talk said, “Yep.”

They had found something, and they would have to remove it. It would be a simple procedure, and I wouldn’t need chemo, just radiation, and he went on and on and on. I didn’t know what he was saying. I’d stopped listening after I heard him tell me they had found something. All I could answer was, “Out! Out! Take it out!”

And then Marcus Welby told me he was retiring. He’d be turning me over to an associate who just happened to be the top breast guy at Weill Cornell. He assured me I would be in the best possible hands. This news just added another level of anxiety to the situation. I was going to miss the good doctor. He always made me feel safe, even when I’d phoned him a few weeks earlier, frantic about a missing left breast.

I’d gotten out of bed that morning and was about to take a shower when I was shocked to discover that one of my breast implants had somehow deflated. I was looking down at my chest and thinking, Whoa! Where’s my left tittie? And then time stopped, and I froze. I was so scared, I didn’t know what to do. I called the doctor, and he told me to come to his office right away.

I don’t know if I was even aware that breast implants had a shelf life. I’m sure they told me as much when I had the job done, but who listens to the details? Well, I heard it this time. Deflation can sometimes happen when implants are left in too long. Mine had been in for a little over ten years.

I decided to remove the old implants a week later and figured I’d get them replaced somewhere down the road. The surgery was no big deal. I only missed a couple of days of work, and now my boobs were both the same size again, just a bit smaller than I’d grown used to.

But for weeks after the operation I kept studying the scars, obsessing about whether they were healing properly. One day I felt something, something that maybe shouldn’t be there—something hard and about the size of a pea. In that hour, right before the Christmas party, I learned I was right. It didn’t belong there.

I hailed a taxi to my showroom for the party with my head spinning a thousand thoughts at once. How was I going to handle this? What if I couldn’t work? What if I died? What if someone at the party asked me about my test results?

Believe me, hosting a party was the last thing I felt like doing, and I didn’t know how I was going to get through it. When I got to my showroom, I just stood outside in the hallway. I looked at my reflection in the glass doors—Mrs. Claus with a frozen expression and breast cancer. Through the doors I could see the twinkling Christmas lights, and there was Chantal, talking and laughing with a group of Betsey girls from my stores. Music was pumping, but I couldn’t recognize the song.

I felt as if I was watching myself and the party from a distance, as if it was a scene in a movie. Whenever I’m stressed or about to start something important, I like to play out in my head the scene I find myself in from a beginning to a possible ending. I try it out in different genres, because as much as I’d like it to be, not everything can be a comedy. I keep re-editing the movie in my head until I find the ending I want. Then I hit rewind to figure out how to get to that finale in real life. I do the same thing with my fashion shows, visualizing the whole finished presentation and then getting to work to make it happen. So why not do the same thing walking into a party with a fresh cancer diagnosis?

Which kind of movie would it be this time? A Busby Berkeley spectacular? Or a Sophie’s Choice gut-wrenching drama? I made my choice. I wasn’t ready for my day to end with everybody crying and commiserating. Tonight I wouldn’t tell a soul about my cancer. So Busby Berkeley it was.

I counted to ten, took a deep breath, and when I finally opened the doors, instead of saying Merry Christmas! I shouted, “False Alarm! It was nothing, whoo-hoo!” My friends who knew about my doctor’s appointment started clapping and toasting me with champagne while the rest of the crowd must have been wondering what the hell I was talking about.

All through the party I laughed, I danced, I drank champagne. I carried on as if everything was fantastic in my world, and everyone helped by having a great time. Right then and there I had to believe that I really was okay. I just pushed the bad news right out of my head. What’s the harm? Besides, this could well be my last Christmas party, so I might as well enjoy it.

As the night wore on I handed out gifts, sat on people’s laps for pictures, and kept dancing in my Busby Berkeley kaleidoscope of a party. I tried to enjoy every moment with all the people I loved in my life. But every so often when I flashed back to the doctor’s news, I would just stop and be still for a minute and then force myself to get right back into the swing of things with a Come on Betsey, you can do it! going through my head.

As the party started to wind down, I realized I was exhausted and looked for Lulu so we could go home. She had brought a friend with her and told me they were going to continue downtown to another party, and I was like, “Uh, Lulu, you can go join your friends in a little while. I need to go over something important with you first.” She could tell from the tone of my voice that I meant business. Regarding the truth about my condition—as with most other aspects of my personal life—there was everybody else, and then there was Lulu.

For everybody else, my gut was telling me that it would be hard to share my diagnosis until I got to a certain place in my own head with it. I mean, why would I tell everybody? They’d just feel sorry for me. Keeping the horrible news to myself seemed like the right thing to do.

You know, at that point in time, breast cancer seemed to me like a private little club. Not many women I knew ever went public about their illness. In an industry that is so obsessed with body image, there was a stigma attached to it. I think illness of any kind always has a stigma attached to it, especially if you’re running a company and so many people depend on you. It was the same a few years earlier with AIDS, when it seemed as if every other day I’d hear about another friend who was sick or had died. I guess it’s human nature for people to want to distance themselves from unpleasant things. I’d seen it in myself.

So much was rushing through my mind. But as concerned as I was with my own mortality, my first concern was for the company. I was actually channeling a vendor’s point of view: “Why should I sell fabric to Betsey if she’s just going to die? How will I get paid?” That kind of thing. ’Cause believe me, in the industry, people do think that way. This breast cancer of mine could easily jeopardize my business. I thought, Screw it. I can handle this in secret.

One thing I did know was that I had to tell Lulu. And she had to know that if she told a soul it could ruin my life. I’ll confess, I didn’t stop to consider how much pressure that might be for her to handle. I just desperately needed her to know.

Her friend went on ahead, and Lulu and I went into our building. The whole time she was fuming, angry that I was cutting into her fun—she had no idea that it was about to get a whole lot less fun. I turned to her and right there in the hallway outside of the apartment I just blurted out, “Lulu, I have breast cancer.” For me, it was one of those special, old-timey, made-for-TV-movie moments where everything goes soft focus. For her, it was a complete emotional turnaround, and she just fell apart. She was crying and saying, “Are they sure? How? When? What do we do next?” All kinds of questions. The ones I hadn’t even had time to ask, let alone answer. This was all brand new to me, and I hadn’t had even a minute to let it all sink in.

I found myself consoling Lulu and managing her emotions, but that was okay. It was nice to assume the role of mother and have the daughter be the daughter for once. Because in our relationship, it’s usually been the other way around: Lulu plays the role of the adult most of the time. That night she didn’t go out to meet her friends. We stayed up late and talked. At first it was all love and death, but I cut that short and we kept things more general, upbeat and girlfriend-y.

Two days later we were supposed to go to Mexico for Christmas, and I wanted to put off the lumpectomy so that we could get away. But Lulu put her foot down and said to me, “We are not going to Mexico. You are going to Weill Cornell! Period. End of story.” She was back in the role of mother.

I thought about it for a minute and then said fine, even though I wasn’t at all ready to face my cancer. I could only deal with certain practical details, like running away. After the operation I figured we would head out to my house in East Hampton for my recuperation. But wait, there was a problem with that plan. Boom! I had no floors at the East Hampton house. Literally. I had just had the first floor and the basement demolished, and they weren’t going to be finished for weeks. Also, I had lent out my apartment in the city to my sister and her family for the holidays. I couldn’t go home.

So directly after the lumpectomy, Lulu and I ended up spending Christmas at the Maidstone Hotel in East Hampton. It was bitterly cold, but our rooms were cozy and had fireplaces. We didn’t do much—there’s not much to do in East Hampton in the winter. And that was perfectly fine. I mostly slept, and Lulu went out for many long, cold walks. It felt as if we were hiding out.

We stayed for a week and when I felt strong enough to travel, we headed down to sunny Mexico—where everyone thought we had been the whole time. No one was the wiser. So far, my conspiracy with Lulu was working.

Lulu was great during this period. I really relied on her strength when I was feeling unnaturally weak. She didn’t talk about the operation or the possible outcome. She knew me better than that. It was business as usual. I am not one to sit around and sulk and feel sorry for myself. She kept me up, up, up and in a positive frame of mind.

When we returned to New York after the holidays, I started right in on my targeted radiation treatments. Thankfully I didn’t need full-blown chemo. Now, I am not exactly a morning person, but when the radiologist tells you to be there at eight in the morning, you are there at eight. You do not miss your zaps. And I was diligent about those zaps!

During the six months of my treatment I kept to my regular work hours. I was busy as usual planning my next fashion show, which ironically enough featured an army of big-breasted Playboy bunnies! I had sketches to do, fittings to see to, a million details to wrangle, and, yes, cartwheels to practice. The doctors had never warned me about the side effects of the radiation—the nausea, the fatigue—and it didn’t occur to me to take it easy. I just dropped into bed, exhausted, at the end of every day.

On an endless loop I kept saying to myself, Just keep working, just keep working. I was on autopilot. In the workroom no one seemed to notice my weight loss or my uncharacteristic lack of energy or, if they did, they didn’t say anything. Not even Chantal, who must have seen a change in my behavior. I guess she figured if I wasn’t going to bring it up, she wouldn’t pry. We had that kind of relationship.

Well, the six months went by. I was done with my treatments, and the doctor told me that I was responding really well. But I wasn’t convinced that I was out of the woods. It was around this time that I got asked by the Council of Fashion Designers of America to decorate a car that was going to be auctioned off at the General Motors annual breast cancer awareness campaign event.

I was a little shocked. Remember, at this point nobody but Lulu knew what I had gone through. It was purely by chance that they had picked me. But to me it felt like too much of a crazy coincidence, as if the universe had a message for me. It was time to share my secret. I went to see the CFDA executive director, Fern Mallis, and asked, “Fern, can you to do me a favor? Six months ago, I was diagnosed with breast cancer. I’m in recovery now and doing great, but I feel like nobody in the industry besides you is doing enough about breast cancer awareness. I mean, Liz Tilberis passed away from ovarian cancer, and no one was talking about that anymore.”

I told her that I had only found the tumor because my breast implant had deflated. Girls needed to know that implants could make it difficult to find suspicious lumps in time—and no one was explaining that to them. I asked Fern if there was any way that I could have the microphone at the start of the event for just five minutes to tell my story.

There were three or four other people in the room milling around while I was relating all this, and I saw that they were crying, and so was Fern! I suddenly realized I had not shed a single tear for my cancer—not at the biopsy results, not in front of Lulu, not during the radiation! But right then and there, in Fern Mallis’s office, I joined right in with a kind of joyful weeping, and everyone started clapping.

All along I had been feeling as if I was this girl who had a tiny, tiny story to tell but when I saw such heartfelt reactions, I got it. It hit me. I had gone through a life-altering event. My downplaying my cancer in my own head had helped me get through the treatment but had also blinded me to the enormity of my situation.

An hour before the CFDA event, I gathered my entire staff in the showroom and told them the whole story. I wanted them to hear it directly from me and not have to read about it afterward. And just as I knew they would, everyone fell apart. At that moment I felt my decision not to share my news earlier was the right one. I can handle a lot—God knows—but I just wouldn’t have been able to face those tears on a daily basis. That would have just made me feel worse.

But then I noticed Chantal turn away, go into her office, and close the door. I had no idea what I could say to make it right with her. My assistant let me know it was time to leave for Bryant Park, and we left without my sorting out anything with Chantal.

I walked the few blocks with my assistant in silence. When we arrived at the event, I saw that the place was packed, and the press was out in full force. I hadn’t written a speech and didn’t even have a plan as to what I was going to say. I trusted that the words would just come to me.

When Fern called me up to the podium, I immediately went on automatic and started talking. I was having another one of my out-of-body cinematic experiences. This time I was General Patton addressing the troops. I was not really aware of what I was saying and before I knew it, my speech was over. The entire audience was on their feet applauding and that was it. The secrets, the lying—my conspiracy of silence—gone in just two minutes.

I posed proudly next to the hot pink breast cancer awareness car I’d designed. I’d painted two large busty pinups on the hood. Those girls seemed like the perfect illustration and the absolutely best punctuation to my story.

On the short walk back to the showroom I felt as though I was floating. I was breathing again and grinning from ear to ear for having finally shared my secret.

But when I got to the door, I remembered I still had to face Chantal. Before I had a chance to prepare myself, she grabbed my hand and pulled me into her office. I was dreading a harsh reprimand and hoping for a quick “How could you?” Instead she surprised me. She looked me directly in the eyes and said, “I am so sorry I didn’t know.” And then a gentle hug. No anger, no judgment. Just the most perfect comment she could have made.

Telling my family didn’t go quite so smoothly, but we survived. They would have welcomed the chance to help and support me, and I had denied them that. I was forgiven because they understood I had my reasons—even if they didn’t like them.

The day after my disclosure at the CFDA, I made the front page of the New York Post. The headline read “Implants Saved My Life!” That still makes me chuckle. I had no idea they were going to run a story, let alone give me the cover. I only found out when Chantal threw the paper on my desk with a smile. The phone didn’t stop ringing all day. My little speech had worked, and so much better than I had thought it would. The New York Post article ended up being an incredible way to get my message out to so many girls at one time. The message being that girls needed to be more engaged with their health. It’s fine to have implants, but take responsibility for some sort of follow-up! If I had had mine checked when I should have, Marcus Welby might well have found my tumor when it was smaller and less dangerous. But I’m not one for looking back and am just happy to have been given this unique opportunity to speak out.

I made the cover of the Post!

My whole cancer ordeal was over and done within six months. And, touch wood, it has never come back to rear its ugly head. I know and appreciate that I am one of the lucky ones. And believe me, I am diligent with my check-ups now.

I continued to be very supportive of breast cancer awareness. Hosting events at my stores was a no-brainer—the stores were already pink! To this day, I still make it a priority to donate money to research. We’d all like to see more survivors and maybe even a cure, right?

I understand that some women who survive breast cancer worry that part of their womanhood was lost under the surgeon’s scalpel. I don’t feel that way at all. I’d rather have my life, thank you very much. As for getting new implants, I never got around to it. I didn’t feel the need.

So today I’m as flat as a pancake—same as when I was growing up—and believe me, I’m just fine with that.