3-D Nipple Tattoos After Breast Cancer Surgery: An MSK Specialty

Rachel Samuels Rand (l) with her husband, Brendan Rand. After a double mastectomy performed at Memorial Sloan Kettering, Rachel got realistic 3-D nipple and areola tattoos by MSK specialist Alicia Jones. Rachel says that getting this done before her marriage to Brendan “was so wonderful because I could feel like my whole self on my wedding day.” (scroll right to see more photos) (photo credit: Jamie Levine Photography)

MSK Physician Assistants Eden Davis (l) and Alicia Jones are specially trained to tattoo highly realistic, 3-D looking nipples and areolas on people who have them removed during breast cancer surgery.

MSK specialists in tattooing realistic nipples and areolas meet regularly to practice new techniques on artificial skin, as seen here. Nine physician assistants in MSK’s Plastic and Reconstructive Surgical Service give tattoos, called “medical micropigmentation.” Left to right, Alicia Jones, Emily Clark, Nicole Costigan, Stephanie Mendez, Caitlin Giles, and Erin Reynolds. Not pictured: Casey Sawicki, Lauren Sarro, Cayla McKernan and Jenny Jackson.

• MSK has specialists who tattoo realistic-looking nipples and areolas for people who had them removed during breast cancer surgery.
• The technical term for this kind of tattooing is “medical micropigmentation,” and it is one of the many services of the MSK plastic and reconstructive surgery surgical service.

Rachel Samuels Rand recalls watching in amazement as a Memorial Sloan Kettering Cancer Center (MSK) specialist tattooed realistic-looking nipples and areolas on her chest after they were removed with her breasts during surgery.

“My mind was blown,” she says with a laugh. “I remember thinking, ‘Oh my God, these look so real and so good. I’m regaining these parts of my body that I really felt were missing.”

Rachel is one of several hundred people each year who opt to have three-dimensional-looking nipples and areolas tattooed by specialists who are part of MSK’s Plastic and Reconstructive Surgical Service.

BRCA1 Mutation Increased Rachel’s Risk

Rachel’s journey began when she was told at age 25 that she had inherited the BRCA1 gene mutation. Rachel quickly learned that she “was at really high risk of developing breast cancer, as well as ovarian and other cancers.” She also learned that BRCA mutations can be inherited from a person’s father as well as their mother — a lesson she believes other people facing cancer need to know.

Rachel, who is a special needs teacher at an elementary school in Manhattan, says the anxiety of fearing she was highly likely to develop breast cancer “was terrifying” — “I dreaded getting breast cancer screenings because I was so scared.” She explains: “I decided to be proactive and get a prophylactic or preventative mastectomy, which involved removing both breasts, including the nipples and areolas.”

Rachel made this decision in close consultation with her team at MSK, including plastic and reconstructive surgeon Babak Mehrara.

Rachel had another life-changing event on the horizon, too, as she prepared to marry her fiancé, Brendan.

Why Tattoo Nipples and Areolas After Breast Cancer Surgery?

MSK offers many different treatments for people dealing with breast cancer, including the surgical removal of one or both breasts, called mastectomy. In some cases, a nipple-sparing mastectomy is possible, as is nipple reconstruction. But sometimes one or both breasts may require surgery that entirely removes the nipple or areola.

The MSK Plastic and Reconstructive Surgical Service offers many different options for people who want breast reconstruction after surgery, including breast implants and using tissue from another part of a patient’s body, often called flap breast reconstruction surgery. Some people prefer to have no reconstruction.

The option to use tattoos to mimic body parts is technically known as “medical micropigmentation.” But that clinical-sounding term can have deep emotional roots.

Eden Davis is a physician assistant at MSK and one of the specialists who tattoo realistic-looking nipples and areolas on people who have them removed during surgery. “So many women who I’ve tattooed say: ‘I want a sense of normalcy when I come out of the shower and look in the mirror or change clothes at the gym. I don’t want to be self-conscious.’”

Rachel says her reaction after her surgery came as a bit of a surprise. “I didn’t think about what a difference it would make to lose my nipples and areolas. But when I looked in the mirror, it was really hard to feel confident. Something that had always been there suddenly wasn’t, and I just felt empty. It makes you look at yourself differently.”

Eden says that’s a common theme among people she tattoos. “I see women of all ages and all phases of life. And many of them say: ‘I’m doing this for me, not anyone else. Even if no one else sees it.”” For Eden, that’s precisely the right reason. “I tell them, ‘You’re the one who has gone through this journey, and you deserve to have it completed in a way that makes you feel like you’ve had a sense of normalcy restored to you.’”

That’s a sentiment Rachel knows well — particularly during her wedding. “Getting the tattoos done before my wedding meant the world to me,” she explains. “Of course, no one is seeing anything as I’m walking down the aisle. But it was so wonderful to feel like my complete self on my wedding day.”

Why Is MSK So Successful at Nipple and Areola Tattooing?

A common reaction from people who undergo the procedure at MSK is to be happily stunned by the realism of their tattoos. That’s the result of intense training and attention to detail by MSK specialists.

Eden explains, “Five years ago, some of us at MSK who do this work went for training at the Sauler Institute of Tattooing, which is well-known in this field.” The training, says Eden, “improved our technique and aesthetics, including into how to use colors — particularly white, to make it appear as if there are light reflections, and darker shades underneath to create shadows. That makes a huge difference in the tattoo appearing three-dimensional and real.”

The MSK specialists also upgraded to the very best tattoo equipment and honed their skills in depicting different skin textures and tones.

Eden says: “I see many tears and near-tears at the end of a session because people can’t believe what a difference this can make. It’s a really emotional day for the people we care for — in the best way. It’s an honor to help people with this last step of their journey.”

Rachel says her own tattooing, done by physician assistant Alicia Jones, “is absolutely amazing.” She adds: “I actually think they are better than the originals! I’ve shown the work to my girlfriends, and all of them are shocked at how real they look.”

New Options for Patients in New York 

More patients in New York will have access to 3D nipple tattooing, thanks in large part to a new bill signed by New York Governor Kathy Hochul which requires certain insurers to provide coverage for breast cancer survivors who want to be tattooed by a physician, as part of breast reconstruction surgery. 

Babak Mehrara, MD, Chief, MSK Plastic and Reconstructive Surgical Service says of the law: “By addressing both the aesthetic and emotional aspects of recovery, these procedures help patients regain a sense of wholeness and confidence after their battle with breast cancer. The bill signed by Governor Hochul marks a significant milestone for breast cancer survivors in New York, ensuring that all patients have access to comprehensive care that fully supports their journey to recovery.”

Why MSK Is Better Than a Tattoo Artist After Breast Surgery

Not surprisingly, some tattoo artists who are not in the medical field also offer nipple and areola tattoos. But Rachel says, “For me, there was never any question: I feel safe and cared for at MSK. Plus, I knew MSK had the highest level of hygiene.”

MSK’s specialists also understand the impact of cancer treatment. For example, “Sometimes radiation therapy can change how skin accepts tattoo ink,” explains Eden. “Based on our medical experience, we can anticipate what’s best for the patient, such as when two sessions a few weeks apart may be better than a single session.”

That is also a testament to the high volume of people who are tattooed at MSK — more than 700 a year, which is far higher than commercial tattooers. “We get all nine MSK artists together every few months to discuss new improvements we’ve discovered and solve any challenges,” says Eden.

She also points out that most of the people MSK tattoos were treated at MSK. “That means we have photographs from before a person’s surgery, allowing us to give the closest possible match to how they used to look,” Eden explains.

Perhaps no factor is more important than the human touch, however. Rachel says, “I felt so cared for when my tattoo artist, Alicia, collaborated with me to make sure the color, texture, and placement was exactly what I wanted.”

Eden says giving a patient that sense of control is the top priority. “We custom-mix each color we use, so we can match any skin tone to the patient’s satisfaction. It’s really about restoring a sense of control to the person we’re caring for.”

For Rachel, the results were both visually amazing and a big psychological boost. “They really are artists at what they do,” she says. “And best of all, they make you feel like family.”