My double mastectomy in 2020 included the removal of my nipples. This was a conscious choice to reduce my chance of cancer recurrence. While some women may opt for nipple-sparing surgery, many women with breast cancer lose their nipples when they have surgery.
Many of us wonder if we should replace our nipples with areola tattoos.
I met Christina Siegel via Instagram and was excited to learn that she was also located in the Columbus area. We've now met in person several times, and I thought it'd be fun to do a Q&A about mastectomy nipple tattoos.
So without further ado, Chrissy Siegel of Living Story Tattoo.
What is 3D tattooing?
A portrait tattoo, but instead of doing a portrait of someone’s face, you’re doing a realism tattoo of a nipple. So you’re trying to create a 3D projected object off of a flat surface.
How do you figure out how to design the nipple if no one has pictures of what their real nipples looked like pre-cancer?
Sometimes they are able to get the pre-surgical photos from their breast surgeons. In those situations, I try to match them. But if they don’t have photos of their pre-cancer nipples, during the first hour of the consultation, we talk about size, shape, placement on the breast, detail, planning, etc. Planning is always about an hour, then tattoo time is about 35 minutes/side.
Can you describe the tattoo process?
I free-hand the nipple - this involves creating an outside perimeter, then the nipple perimeter, and then I fill in the rest based on the look that the woman wants.
What kind of training should you look for when looking for a nipple tattoo artist?
I believe that breasts are on our body, so body tattooers are the most equipped to do breast tattooing. Look for someone who has the experience and a good foundation of tattooing on healthy skin before they start tattooing reconstructed skin. There are tattoo apprenticeships - mine was about 7 months long, I learned different machines, needle techniques, principles of light, etc. Look at their healed pictures before committing to anyone. Ask for healed pictures of someone who looks like you: if you had DIEP flap surgery, ask to see those, if you had brown skin, ask to see pictures of brown skin, etc.
How do you find a competent nipple tattoo artist if you’re not local to Columbus, OH?
There are a couple of places that have artist directories. Areola Restorative Tattooing, under meet the artist, has a list of people she’s trained who she endorses.
Do you have to wait a certain time after your last surgery before getting nipple tattoos?
Ideally, I tell people 6 months out from surgery is good. It depends on what the last surgery was tough. If it was opening incisions, wait 6 months. If it was something like fat grafting, 6 weeks. Sometimes people have to wait a year if they’ve had top surgeries. If they've had nipple necrosis surgeries, they may need to wait longer than a year.
How many appointments does one need to get the desired look?
I schedule people for 2 appointments. The first appointment for a bilateral usually takes ~3 hours (1 hour for a consult, 1 hour for the tattoos, then aftercare). The second appointment takes about 1.5-2 hours. For unilateral tattoos, the first appointment is 1-2 hours, then the second appointment is about 1 hour. At the end of the first appointment, I schedule the second appointment. Anticipate 10 weeks in between appointments. 14 days for healing. A skin cycle is 28 days, so you go through 2 skin cycles so I know how your skin behaves and if you need a touch-up.
Do nipple tattoos require touch-ups?
I bring everyone back about 8-10 weeks and sometimes things need to be evened out, color may need to be adjusted by adding layers. The 3D nipple portion may require some more shading to make it look more projected. You have to build upon the shadow after the healing process to make it look as realistic as possible.
I use body tattoo ink that happens to be in nipple colors, so it lasts a long time. The lighter colors are made of more titanium dioxide and they fade more over time than darker colors that are more carbon-based.
What is the aftercare like?
TJ trained me to wash with soap and water, pat dry, then a thin layer of ointment, and then a non-stick pad inside the bra. Then you’ll seep plasma for a couple of days on the non-stick pad. This is normal. Then they'll start to flake days after 3-7. Usually, they’re healed by days 7-10, and then you can switch to applying an unscented lotion for another 7-10 days. Don't immerse the tattoos in water for about 14 days - showers are OK. Don’t do strenuous workouts until they start to dry out and peel.
Can you get nipple tattoos if you’re undergoing chemo or radiation?
No. With chemo, I like people to be at least 6 weeks out; counts have to be good, and you have to have a note from your doctor. With radiation, it should be closer to 1 year from the end of radiation because the skin needs to heal.
Do you convert radiation tattoos for patients?
I neutralize them so they look more like a freckle. Usually, we only do the midline ones because those are the ones that people see and focus on. I go across the color wheel and usually add pumpkin orange and it turns it into a freckle.
How much does nipple tattooing cost?
For bilateral tattoos, it’s $500 (for both visits) and payment in full is required during the first visit. For unilateral tattoos, it’s $350. It’s about $100/hour. I may have to increase prices due to inflation after January 1, 2023. Of course, prices will vary from artist to artist.
Is this procedure covered by insurance?
It can be. It depends on the patient’s plan. I provide codes based on their medical history and give the patient my NPI and tax ID number. I tell them to call their insurance and see if they’ll cover the procedure. Nipple tattooing is covered by the women's health and cancer rights act of 1998 at the federal level - all women have a right to breast cancer reconstruction and if they keep a breast, they have a right to have the breast made symmetrical at the federal level. Some patients get full reimbursement. Typically patients get about 50% coverage of the cost of nipple tattooing. I am seen as an out-of-network provider, so coverage will vary from plan to plan.
What do you recommend for women who aren't sure if they want nipple tattoos or not?
They should try nipplebacks. They're temporary tattoos that look like super realistic areolas. Apply them and see how you feel when you look in the mirror. Live with them for a couple of days to see if they grow on your or not.