All about mastectomy tattoos with Amy Black, renowned tattoo artist & founder of PinkInkFund.org
Introduction to Mastectomy Tattoos
Healing Through Art. Tattoos can be an important component of healing for many women following their mastectomy surgery – both those who chose to reconstruct their breasts AND those who chose to go flat. Tattooing can be a way for women to take back ownership over their bodies, having had so little control during breast cancer treatment.
Restorative vs. Decorative. For some, tattoos can restore the appearance of their lost nipple/areola (restorative, or reconstructive tattoos). Others choose mastectomy tattoos that are decorative (also called artistic, or “scar covering”) rather than anatomic, and that hold special meaning for them – flowers, vines, words, and designs of every shape and color.
Insurance & Other Considerations. Unfortunately, many insurance companies do not provide coverage for mastectomy tattoos. Those that do, only cover restorative (not decorative) tattooing as part of the “breast reconstruction” process. Patients considering mastectomy tattoos should also be aware that not all tattoo artists will produce optimal artwork, because tattooing is a largely unregulated field, and particularly for restorative tattoos should seek out a licensed artist specializing in this area who can display a portfolio of previous work. (More about logistics and risks.)
Mastectomy Tattoo: a tattoo that is drawn on top of the mastectomy site, usually to cover mastectomy scars – includes both restorative tattoos (restoring the nipple/areola) and decorative pieces (non-anatomic) of various sizes.
Restorative Tattoo: A highly specialized practice of paramedical tattooing, which restores the appearance of the nipple and/or areola (reference). Surgical reconstruction of the nipple can produce a nipple-like contour (shape) but permanent coloration and detail restoration requires modification with ink.
Gallery of Amy’s Work
View more flat closure mastectomy tattoos at our Gallery Page.
How did you, as an artist, become interested in mastectomy tattoos?
I became aware of them because of a fellow tattoo artist doing them long before I did back sometime before 2010. I did not pursue an interest in doing them though, I was approached by a cancer survivor asking if I was capable of creating a 3D nipple for her to match her other natural breast in 2010 so the opportunity came to me. I did not know at the time it would flourish into what it has become today and I’m very grateful and honored to be of service to people in need with art.
How do patients find a tattoo artist? Is there a coalition or national organization? Steps to take?
It has all been fairly organic with the sporadic major media. There are small organizations here and there throughout the world. Many of the breast cancer support groups now know of tattoo artists that they tend to refer to others, and some people do their own research as mastectomy tattooing has become far more visible online since 2010. I get referrals from both healthcare, organic online discovery, and cancer support groups as well as word of mouth from other survivor clients.
What are some considerations patients should be aware of when considering a tattoo? Medical, emotional, financial, etc.
They should definitely make sure the tattoo artist/shop has all the proper licensing needed per health department/etc. The artist should have good examples of their work available that includes examples that are similar to what the client is looking for. Make sure to communicate with the artist as much as needed to make sure you feel comfortable with them both professionally and artistically, that they understand your vision in order to create it for you on skin. Emotionally: it’s unknown how someone will feel throughout the process, having some nerves before the process can be totally normal and understandable, just try to approach it as calmly and grounded as possible in order to make the best decisions and be able to have the best experience you can. Financially it will change from person to person as every artist charges differently for their craft.
Are there health risks to tattooing over the mastectomy site?
There are always inherent risks with getting tattooed in general. If you find an artist who has experience working with scar tissue, specifically post mastectomy scars and other types of affected tissue (i.e. radiated skin, etc) would be best. Health risks can vary since artists use different products for pigments, cleaners, needles and more, so unfortunately there are probably too many variations to be able to answer this in one simple answer. There is always the chance someone could be allergic to the ink(s) used or other products used during the tattoo process, and sometimes that will not be known until after the tattoo process has begun or after it is completed. There will always be a risk of infection if the artist is not following proper protocol with proper hygiene, and the same risk also applies to the client if they do not follow proper healing instructions and hygiene.
Are there certain inks that are a better choice for oncology patients? We understand that tattoo inks are not regulated by the FDA.
Since not all tattooers use the same brands of inks, it’s unknown if there are some who use lesser quality inks or not. I can only speak for myself, where I only used inks that have time tested quality standards, and operate with high standards in their businesses so I feel confident that any colors I choose to apply should be the best choice(s) for each specific client.
Have you ever had a client who regretted getting their tattoo?
If I do, I have not heard from them. I have a vague memory of one person many years ago later wishing they did not get the tattoo purely because they realized they just did not want to be tattooed later in life, not because they were unhappy with the work that was done. I pre screen clients pretty heavily to make sure they are not making a mistake, and have even turned away or even lost clients because i would rather tell someone to not get tattooed than to get tattooed: tattoos are not for everyone and should not be taken lightly.
What’s the typical timeline between surgery and tattooing?
A minimum of 3 months is typically needed for anyone, some clients need more than that, waiting for discoloration in the scar lines to dissipate is important for the best tattooing possible, as well as treating any scar tissue that can sometimes transform and create a surface that is not best for tattooing, but that is again a case by case basis.
Do reconstructive tattoo artists typically work with medical professionals?
Not sure, I only know a handful and most do but not all of them do.
How does insurance coverage and financing work?
Insurance will only reimburse for nipple tattoos, not decorative mastectomy tattoos, and it will vary per carrier and level of coverage the person has on whether they will reimburse full, partial or nothing. It will also be affected by if the person is tattooed by someone who is a recognized “in network” or “out of network provider” whether a carrier will consider reimbursement or can process the claim for the client. Financing will differ from artist to artist on a per case basis sometimes. Right now there are only 2 mastectomy tattoo non profits I am aware of in the United States: Pink Ink Fund (which I founded) and the P.Ink Project which offer varying levels of financial assistance.
Speaking of financing, can you tell us about your nonprofit, the Pink Ink Fund? What inspired you to found this organization, and why is this work so important?
The Pink Ink Fund was inspired by doing my first few mastectomy tattoos, being a self employed artist who did not have insurance for many years, and suspecting there were probably many others like myself without insurance and all the means to pay for treatment let alone getting some critical artwork done to help heal after dealing with cancer. I didn’t want someone to be blocked from receiving art that could help change their lives for the better.
Taken from the mission page of the charity’s website:
“Pink Ink Fund will raise money and solicit donations in order to offer financial assistance, education, and outreach to those in the community needing post mastectomy reconstructive, restorative, and recovery tattooing. Pink Ink Fund, in partnerships with the medical community and service care providers, will work to educate cancer patients, survivors and those genetically predisposed to breast cancer on their full spectrum of options on breast, nipple, and areola reconstructive tattooing following mastectomy surgery...”Pink Ink Fund Website
Do you think that mastectomy patients generally know about tattooing as an option?
Ten years ago there was very little knowledge about tattoo options coupled with only a few tattoo artists around the world doing this kind of work. Fast forward to 2020 and it has increased a lot, but there are still clients contacting me that do not have all the information they should have on it. I’m hoping one day when I can step back from tattooing a bit I can help spread education further to make sure every patient knows their full amount of options.
Do you have any comments or feelings about the aesthetic quality of the mastectomy closures you have seen in your career? Do you think the quality of the closure affects their tattooing experience, and if so, how?
Not being a surgeon, I can not begin to imagine the complexities and difficulties of their jobs not only recreating body parts but also closing up areas of tissue to ensure the best healing and results they feel are possible. I know that some patients are great candidates for certain products and techniques, and others are not, and sometimes they may have the best closures but something happens to make perfect healing not possible. In the end, the smoother and less visible scarring is always best for everyone, but that can be difficult if the patient chooses large implants under tight skin, or there are allergic reactions that happen, infections and more. Since I’ve had to work with every incision line I can think of at this point, and a variety of scar tissue, I have found that there are often solutions that work for my clients with using art to help cover, redirect or even sometimes highlight the areas they want.