How 3D Post-Mastectomy Nipple Tattoos Help Breast Cancer Survivors

Irena’s self-esteem took a tumble after her double mastectomy. It wasn’t because she wasn’t healthy, or even because she didn’t have breasts anymore — she got a breast reconstruction not long after the procedure. But she was without nipples, and it got to her. “I was depressed,” she tells Allure. “I could not look [in] the mirror and change clothes, even at a swimming pool. I felt very uncomfortable if somebody [would] see that I had no nipples, only breasts.”

CNN reported last year on a study published in Annals of Surgery that showed that the rate of double (a.k.a. bilateral ) mastectomies tripled in the 10 years between 2002 and 2012. Not everyone opts to have their breasts reconstructed after a mastectomy — it's a matter of individual preference — but many do. And, like Irena, they’re often left without nipples. That absence can take people who have already been through so much on yet another emotional rollercoaster.

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The good news? For those who want the appearance of nipples (again, it’s a personal choice), there are options. There’s surgical reconstruction. There are nipple prosthetics. And then there are 3D nipple and areola tattoos, which can be done by a medical professional or a tattoo artist.

"I was depressed. I could not look in the mirror and change clothes, even at a swimming pool."

Irena went with the latter and underwent the procedure in 2015 at New Jersey’s Beau Institute, a permanent cosmetic institute that specializes in advanced corrective cosmetic techniques.

Beau Institute offers all sorts of permanent cosmetics, but nipple and areola tattoos are something the founder, Rose Marie Beauchemin, feels particularly passionate about. This October 24, Beau Institute is holding its seventh annual “Day of Hope,” during which it will provide those who have undergone mastectomies with complimentary 3D nipple and areola tattoos. Typically, Beau Institute charges $350 per areola for tattoos. While nipple and areola tattoos may be covered by insurance when done in medical settings, Beauchemin says it isn’t when done by tattoo artists.

“I started the Beau Day of Hope when I realized how many women are out there that have never followed through with the tattoo after receiving a mastectomy,” Beauchemin tells Allure. “The reason was, they were under the impression their completion required another surgery for the nipple, which would be a nipple graft."

Many of those who have had mastectomies and reconstructive surgery have also been through chemotherapy and radiation, Beauchemin says. They aren't willing to undergo another surgery, even if they miss having nipples — Beauchemin says some Beau Institute patients have "shared that their husbands have not seen them undressed for five to seven years, or they haven't looked at themselves in a mirror for several years" — and they don't know that 3D tattoos are an option.

Beauchemin also uses the Day of Hope to spread the word to other practitioners, teaching nipple tattooing to artists and medical professionals as part of her practice. “Think about how many women we can service by offering this completion,” she says.

Beau Institute

As for what, exactly, 3D nipple and areola tattoos are? “They are essentially tattoos that use shadowing techniques to give the appearance of being a 3D structure,” board-certified plastic surgeon Alexes Hazen, director of NYU Langone Health's Aesthetic Surgery Center, and board member for the AiRS Foundation, tells Allure. “They have been around for years with very specialized tattoo artists, but are more popular now, as tattoos are both more popular for medical and cosmetic reasons.”

Hazen notes that tattoos are a simpler option than nipple reconstruction, which "requires stitches and more extensive healing and more risk of infection,” she says. “A tattoo is like an abrasion and is usually healed within days.”

Then there’s the fact that nipple tattoos don’t actually protrude like real nipples. “A 3D tattoo gives the illusion of a 3D object, such as a nipple, but when you touch it, it's flat,” Hazen says. “A reconstructed nipple is just that and has the feel and look of a nipple, including the three-dimensional aspect.”

That’s not to say one is better than the other, but it’s certainly a consideration. For Irena, one of the benefits of her flat nipples is not feeling the need to wear a bra. As Beauchemin points out, surgically created nipples don’t contract like natural ones, so they’re always poking out. Of course, some patients may not mind a protruding look — but many feel "really committed to wearing something thick enough to hide that nipple," Beauchemin says, "and I’ve actually had clients who have had that nipple reduced because it shows through everything.”

As for the tattoos, just because they don’t protrude doesn’t mean they don’t look like they do. “What makes it 3D is something called simultaneous contrast, which is simply light against dark,” Beauchemin says. “So if you start out light in the center, and then a small area of dark, and then a small area of light once again in a circular or ovular motion, and then dark again for the areola — what you’re going to get is the illusion of protrusion.”

Beau Institute

Aside from that, Beauchemin says the process of getting one is like getting any other tattoo, except that with nipple tattoos, the practitioners use pigment instead of ink. She says the pigment is sterile and safer, but that it does fade over time, so patients do need to go in for touch-ups every once in a while. The whole process, Beauchemin says, takes about an hour and a half for two breasts.

So, who can get the tattoos? “Most patients would potentially be candidates for this technique,” Hazen says. “The only issues are the quality of skin and if it has been damaged due to radiation or recent surgery. But in a well-healed patient, with a sterile technique, they are quite safe.” She notes that people typically wait anywhere from six weeks to four months to heal from the breast reconstruction before they get the tattoos.

In some states, such as New Jersey (where Beauchemin works), the law requires patients to get medical clearance from their doctors before they can get the procedure done by a cosmetic artist. But even if that’s not the case where you live, it may be a good idea to get the go-ahead from your doctor anyway. “I don’t know this case inside and out like the surgeon does,” Beauchemin says. “I always want that clearance [in case] there was a complication I’m not aware of.”

For Beauchemin, the best part of providing the tattoos is patients' reactions. “They step up to the mirror and it’s so emotional,” she says. “They feel familiar, they feel whole, they feel confident, they feel feminine — and that's a nice thing to be able to be a part of, to be able to restore that and be any part of...making a woman feel better.”

"They step up to the mirror and it’s so emotional... They feel familiar, they feel whole, they feel confident"

And for Irena, at least, that was definitely the case. After she got the tattoos, she quickly went from hiding her breasts to showing them off whenever she could. “When I got my nipples back, I had [the] desire to show...all my friends,” she says. “You start blooming and you want to show everybody."

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