Sherrie Walter will never wear earrings again, but recently started styling her hair in a ponytail the way she used to before she was diagnosed with skin cancer nearly four years ago.
It's a big step for Walter, whose life was turned upside down when doctors finally figured out the persistent sore in her ear was actually basal cell carcinoma, the most common form of cancer. By then it had spread so much that the Bel Air mother of two had to have part of her skull and most of her left ear removed.
But surgeons at Johns Hopkins Hospital have constructed a new ear for the 42-year-old Macy's manager and, feeling like her old self, Walter is again enjoying ponytails and other simple things in life. On Tuesday doctors performed the last major surgery in a series of procedures spanning 20 months to finish the ear.
The rebuilding is believed to be the most complicated ear reconstruction in North America. The new ear is made from cartilage, skin and arteries from other parts of Walter's body. The ear spent four months implanted in her forearm so skin could grow around it.
The ear had been attached in a January surgery, but looked more like a ear-shaped blob sealed against Walter's head. On Tuesday, a group of surgeons led by Dr. Patrick Byrne created an earlobe and shaped it to look more like a real ear
Dressed in a hospital gown before the surgery, Walter was a ball of jitters, both anxious and grateful to soon have her own ear again. Byrne reassured Walter and calmly answered her questions.
"The whole goal is to get you two ears to match," he said.
Walter calmed a bit and joked that he also might stretch the other side of her face and get rid of some of the wrinkles.
"You won't need that for another 15 years," Byrne said.
As doctors prepared to wheel Walter to the operating room, she sighed: "I am one step closer to the end, to looking normal again."
Walter didn't think much about it when in 2008 a scab on her ear wouldn't go away.
"I kept breaking it," she said. "I thought it was something I was doing that wasn't allowing it to heal."
Her primary care physician prescribed antibiotics but the sore persisted. Eight months later with no change, Walter made an appointment with a dermatologist.
"She looked at it for less than five minutes and she said, 'You have cancer,'" Walter remembered. "I looked at my mother and I looked at myself and it was too much to comprehend."
Walter assumed treating the cancer would be simple. "You remove it and you're good," she said.
It turned out to be anything but easy.
The doctor cut away seven layers of skin, which left the inside of her earlobe fragile and delicate but still intact. All seemed fine until Walter discovered blood in her ear in October 2010 and went to the doctor to discover that the cancer had spread into the ear canal.
An aggressive treatment was needed because the cancer also had spread beyond her ear. Doctors removed Walter's ear canal, ear drum and most of the outside of her ear in a 16-hour procedure done around Christmas. They also had to remove neck, gland and lymph node tissues and part of her skull around her ear where the cancer had spread. She then went through weeks of radiation.
Life seemed bleak. Although Walter was glad to be alive, living without an ear had its difficult moments. She could no longer hear on her left side and worried about how she looked. She started wearing her hair long and in a way that concealed her face.
Byrne, an associate professor of otolaryngology at the Johns Hopkins University School of Medicine, assured Walter that she had options.
She could get a prosthetic ear that could be attached each day. Most people with prosthetics attach it with clips to a titanium rod, but Walter's skull bone had been removed and could not support the rod.
"She would have had to deal with tape and glue and it would have been a royal pain in the butt," Byrne said of a prosthetic. "It just didn't sound appealing to her. And I agreed."
He suggested Hopkins doctors could give her an entirely new ear. The thought gave her hope.
"It seemed a little strange, but I was willing to try it," Walter said.
Byrne and his team of surgeons used cartilage from Walter's ribs to construct and carve an ear, a procedure that takes hours because cartilage is hard and not easy to work with.
Facial and neck skin is usually used in ear reconstruction, but Walter didn't have enough because of her previous surgeries. Doctors chose to use the skin of the forearm as an alternative.
Because the forearm skin doesn't stretch well, Walter's had to be expanded using a balloon filled with saline — a process that took several weeks. The tissue expander then was removed and the new ear placed in the arm so that skin would grow around it.
"We implanted the ear near the wrist and just let it live there so all the skin could grow into the ear," Byrne said.
Walter called the stretching process painful and having an ear in her arm strange. People saw it and gawked. She didn't use her arm much during those months because she worried about hitting and damaging it.
But Walter said she and her family learned to joke about the ear and even used it as a coping mechanism. When she got tired of her children's whining she'd stick her arm in the air and say, "I can't hear you." Her 9-year-old son thought it was kind of cool and would beg her to show it to people.
After doctors harvested the ear from her arm and reattached it to her head in January, she began to feel more comfortable, starting to put her hair up again, for example. But it still didn't look quite real.
On Tuesday, Byrne worked to make the ear more realistic. He cut the skin below the ear and pulled it back so it would lift the bottom of the ear to create a lobe. He then peeled away the skin from the rest of the ear and, like an artist carving a figurine, cut away at the cartilage to create the appearance of a canal and the normal indentations of the ear.
As he carved, another doctor worked on Walter's right side digging more cartilage out of her ribs that would be used to lift the top of the ear up and away so that it doesn't lie flat.
Slowly shaping cartilage the consistency of a bar of soap, Byrne carved a fine line between getting the best-looking ear and not damaging his creation.
Walter probably will need a few minor touch-up surgeries after Tuesday's procedure. She won't be able to wear earrings on the new ear for fear of damaging it. She had four piercings on her old ear. She hears now on the left with a bone-anchored hearing aid.
Once she heals, the new ear should last for years, Byrne said. With artificial tissue, there is a risk of the ear's eventually breaking down, he said. Natural human tissue can last for a long time.
"She is young and hopefully she is cured for 50 years to come," Byrne said.