November 2018 Ask the Expert: Nipple Tattooing

October 26, 2018

After a mastectomyinfo-icon or breast reconstructioninfo-icon, you have choices you can make about how your chest looks. One of those choices is getting nippleinfo-icon tattoos. Specially trained medical tattoo artists are able to use tattoo needles, machines and ink to hide scars or create the illusion of natural nipples. This can be helpful for people who may not want to get more surgeryinfo-icon to rebuild their nipples.

In November, Living Beyond Breast Cancer expert Michael Ham, MSN, RN, CPAN, CCRN, a registered nurseinfo-icon and medical tattoo artist at Penn Medicineinfo-icon and the Sauler Institute of Tattooing, answered your questions about medical tattooing, nipple tattoos and more.

Remember: we cannot provide diagnoses, medical consultations or specific treatment recommendations. This service is designed for educational and informational purposes only. The information is general in nature. For specific healthcare questions or concerns, consult your healthcare providerinfo-icon because treatment varies with individual circumstances. The content is not intended in any way to substitute for professional counselinginfo-icon or medical advice.

My question isn't about nipple tattooing but a general question about the safety of a tattoo after breast cancer. I'd like to get a simple pink ribbon tattoo for my 5-year anniversary celebrating NED (no evidence of disease). Does getting a tattoo increase the risk of lymphedema? If I were to get one, would it be best to get it on the arm in which no lymph nodes were removed?

Congratulations on your 5-year mark! Definitely a reason to celebrate. While tattooing someone with lymphedemainfo-icon or at risk for lymphedema is usually safe, we always recommend discussing with your physicianinfo-icon before getting a tattoo on the affected side. Because of differences in anatomy and triggers for lymphedema, each person’s risks must be carefully considered and individualized. As with any tattoo, it is extremely important to go to a reputable studio that practices proper sanitation and infectioninfo-icon control practices. In addition, it is extremely important to follow the recommended aftercare to make sure it heals well.

I’m allergic to red tattoo ink. Is the ink used for medical tattooing different from ink used in regular tattoo shops?

There are different types of pigments that can be used for tattooing. Your artist will decide what pigments will be best during your consultation. At the Sauler Institute, we often use tattoo ink like those used in traditional body art shops. We ensure that our ink is top quality, manufactured in the U.S., and from a reputable company. If you have any concerns about allergic reactions to tattoo ink, we give samples of the ink so that you can take them to your allergist to have a skin test performed. This will ensure that you are safe to proceed with tattooing.

Will the color of a nipple tattoo ever change or fade like regular tattoos? Can you get a nipple tattoo touched up like a regular tattoo?

Most of the initial fading will occur in the first two weeks as the tattoo is healing. Unless exposed to the sun, your tattoo should last a lifetime. However, because we are working with skin that has been compromised (scarred/moved/stretched/had radiationinfo-icon), everyone responds a bit differently over time. If your tattoo does fade, you can definitely have it touched up. We provide consultation and touch ups to our own work or work performed by a different artist.

I had a double mastectomy with expanders. I’m due for my exchange surgery in February. I’m interested in nipple tattooing. Do I have to pay out of pocket or is it covered by my insurance?

At our institution, we charge out-of-pocket for the procedure; however, we provide a receipt and reimbursement form to submit to your insurance company. On the reimbursement form, we list the codes and procedure names that you’ll need when submitting to your insurance company. You can also call your insurance in advance to find out what they require you to submit for reimbursement.

If you lose weight after you have nipple tattoos, and the size of your reconstructed breasts changes, will the tattoo images become distorted?

With areolainfo-icon tattooing, we are going for an organic appearance without heavy outlines. Minor stretching or shrinking of the skin will not affect the tattoo appearance. Often times, weight loss or gain over time will allow the skin to adjust to the changes. So depending on how quickly and how much weight you lose or gain, it may or may not affect your tattoo. We are happy to touch up tattoos as well in the event that any changes are noticed over time.

Is there any concern that the needles or the ink they deliver might cause an infection in the reconstructed breast areas?

As with any procedure that penetrates the skin surface, infectioninfo-icon is always a risk. We take extra precautions to prevent infection from happening. We clean the area prior to tattooing with alcohol and then immediately cover it with a clear bandage after the tattoo is complete. This bandage stays on for 3 days during the most pivotal healing time and prevents any bacteria or germs from coming into contact with the tattoo. At our institution, we use sterilized, single-use needles and top quality inks. We practice proper sanitation and infection control practices to ensure your safety.

On average, how long does it take to apply tattoos, and what is average recovery time?

We generally book a bilateralinfo-icon aerola and nippleinfo-icon tattooing session, a session where both of your breasts are tattooed, for 90 minutes. Unilateralinfo-icon tattooing, where only one breast is tattooed, is booked for 60 to 90 minutes. This period includes cleaning and marking the area, mixing the colors and performing the tattoo. We review the aftercare with you and ensure that all your questions and concerns are addressed. We also have a lot of fun and ensure you walk out with a big smile on your face!

Healing time varies but for the most part the tattoo is healed within 1 to 2 weeks, with the majority of the healing in the first 3 days. We apply a clear dressing immediately after the tattoo is complete that stays on for 3 days. This helps to prevent infections and speeds up the healing process. There is no downtime for the procedure. You should be able to resume your normal activities right away. However, there are a few restrictions: no vigorous exercise for the first 24 hours and no soaking in any bathtubs, swimming pools or hot tubs for at least 7 days after.

How long after reconstruction should I consider tattooing? Should I consult with my plastic surgeon regarding timing?

Where we practice, we can tattoo you as early as 6 to 8 weeks after reconstruction. We require that your plastic surgeoninfo-icon clear you to proceed with the tattoo. Your incisions have to be healed, with no broken skin or signs of irritation. Also, it is never too late to have tattooing done. Some patients come in years after their reconstruction to have tattoos performed. We work with you when you are ready, to ensure you are comfortable.

I don’t live in your area. How do I find places to get a nipple tattoo done?

Finding a reputable studio and one that you are comfortable with is extremely important. I recommend you search for a medical tattoo artist on the Society of Permanent Cosmetic Professionals site. Go to the public information section, Cosmetic Tattooing, Find Technicians. This is a great way to find a trustworthy artist. Once you find an artist in your area who performs areolainfo-icon and nippleinfo-icon tattooing, I recommend calling to ask about their practice. See if you can come in for a consult to view the studio and ensure your questions and concerns are answered. Ask where the artist purchases their inks, and about infectioninfo-icon control and sanitation practices, blood borne pathogen certifications and recommended aftercare.

Sauler Institute trains medical tattoo artists all over the country and the world! Feel free to reach out to us—we may have trained someone in your area. You can find us at our website.


My tattoo is fading. How often should I get a touch up?

While tattoos are permanent in nature, we are working with skin that has been compromised (scarred, moved, stretched, radiationinfo-icon), so everyone’s skin responds a bit differently over time. If fading does occur, you can definitely have your tattoo touched up. We are always happy to provide consultation and touch ups to our own work or work performed by a different artist. We want you to be happy with your tattoo, so touch-up frequency really depends on how you feel about the color. If you feel a touch-up is needed, come see us!

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