In 2012, 39 year-old Tara Dunsmore was diagnosed with invasive ductal carcinoma, a common form of breast cancer. After undergoing a lumpectomy followed by a bilateral mastectomy, Dunsmore thought she was finally nearing the end of her nightmare when she began researching areola tattoo options the following year. Her hopes soon evaporated once she realized that there simply weren’t any tattoo artists in her area competent enough to do the work.
Anxious to put an end to her painful journey, Dunsmore finally chose to have the job done by a local nurse. She was offered three options; bubble gum pink, chocolate brown or nude. Ultimately, the results looked discolored and unnatural. Profoundly disappointed, she vowed to become a tattoo artist herself. She would train with the best so she could offer clients what she herself had been denied: a proper areola tattoo and the natural looking beauty and wholeness that comes with it.
Upon arriving at her decision, Dunsmore promptly quit her job to train for eight months at the Beau Institute in Mt. Laurel, New Jersey to become a 3D areola tattoo artist. Dunsmore has since tattooed over 300 women and had her own tattoos corrected.
Whenever Dunsmore loses sight of why she made the career change, her clients are happy to help restore it. A case in point was a recent encounter with an older woman who had beaten breast cancer 17 years earlier. When Dunsmore asked the woman why it took her so many years to have the tattooing done, she replied, “I was waiting for you.”
As a cancer survivor herself, Dunsmore is comfortable offering others the wisdom she acquired from her own experience to better help them on their respective journeys. “Check out the facility, the artist and whether your health insurance will reimburse you the expense. And really try to find an empathetic person,” she adds. “Finally, if you need a second opinion, get it! And if you need more research, do it! This is your life and it’s also your choice!”
The photos above show the results of areola tattoing, before and immediately after the procedure. Coloring can appear more red at first. This lasts 24-48 hours, after which the true color and 3D (nipple and Montgomery glands) becomes visible. The full healing process takes at least a week.
Credits: Tara Dunsmore
How Nipple Reconstruction Is Performed
Once the breast implants have been successfully inserted, nipple reconstruction can begin roughly 3-4 months later. Skin used to rebuild the nipple and areola is taken from the breast, back or abdomen. Once the reconstructed nipple has healed, the tattooing can start.
Another option is a 3D areola tattoo that has the appearance of a nipple but is created with ink. These tattoos range from $200-$800, a cost that may or may not be reimbursed by insurance.
Medical aesthetician and areola tattoo artist Juana Shin at Northwestern Plastic Surgery in Chicago has worked on two patients a day, five days a week, for the last three years. Trained in 3D tattooing at the University of Pennsylvania, Shin employs a technique that generally requires multiple two-hour appointments to complete one tattoo.
Although the process is highly effective, she’s also mindful of how great a struggle it can be for some of her patients to have to return to her repeatedly. As such, Shin recently adopted a new 3D tattoo technique that generally only requires one 3½ hour session to complete an areola tattoo. This particular technique is performed using a larger needle and more permanent, richer inks that can be applied with or without nipple reconstruction.
Challenges of Reconstruction
“Ninety percent of my clients say ‘Do whatever you want’, and in return I always ask them, ‘Well, tell me, what do you want?’” relates Shin. “By the time they get to me they’ve been on this journey for a long time and are exhausted, not always thinking clearly – they just want to be done with it all.” Shin is there to help her clients and offer them suggestions, but also wants to make sure they’re involved with the process as well. It’s their bodies, after all.
Nipple tattooing can also present unforeseen technical challenges. During Shin’s Penn State training, she saw several patients whose “nipple sparing didn’t take and sometimes dissipated, leaving scar tissue.” She also noted color retention irregularities on some saline implants because of their tendency to ripple “like a flabby waterbed,” requiring patients to return for several more visits in order to acquire the best areola coloring.
Lymphedema, a changing of the color and texture of the skin, can be a reality for cancer survivors who have undergone radiation. Shin recalls the case of “a woman who was light-skinned, but because of her treatments looked African American.” Since Shin is also a medical aesthetician, in some cases she treats her patients with a Vitamin C-enriched, face and body brightening cream for up to 6 months before tattooing. This helps lighten and nourish skin that’s become thin and weakened by radiation.
Another potential challenge is capsular contracture, which causes the areolas to become hard and tight. This leaves no room to stretch the skin, something that is key for color retention. Should patients have these compromised tissues, Shin suggests they return in four-to-six weeks to check the color’s reaction to the skin. “If she comes back happy, I’m happy,” Shin explains. “It’s asking too much for a patient to have to return here three or four times.”
Skin Tones: Choosing a Tattoo
Permanent makeup artist Athena Karsant has 25 years experience with 3D tattooing, and has trained herself to consider different variables when discussing color options with her patients. Skin undertones, the client’s age and the quality of skin she may have after undergoing radiation therapy are some of the factors that need to be taken into consideration. Karsant explains, “I’ll place pigment swabs on the inside of their wrist or on their chest to see which color works best. There’s no one-color-suits-all when it comes to this work.”
Karsant relates how one breast cancer survivor in her early 20s recently came to her for help after her doctor’s hastily performed tattoo job had left her with half black-half pink areolas. “Thankfully, I was able to fix them through color correction, which is a tedious job for both the client and for me,” Karsant explains. “I felt so bad that she had to go through breast cancer, mastectomy surgery and then the frustration of having this botched procedure – not to mention all the time it took to correct the bad tattooing.”
Scarring and Aftercare
“Are you going to cover the scars?” is the most frequently asked question Shin’s clients pose at their first encounter with her. When patients have fully healed except for a red ring (or a scar) left on their breast(s) from surgery, Shin offers camouflage tattooing.
“I don’t offer it to everyone; it’s a case-by-case scenario. Scars are difficult to treat because of pigmentation. Sometimes it just doesn’t look right. We try to blend in with their skin,” explains Shin. With pigmented skin, Shin says she’ll sometimes use bleaching or a brightening cream to help remove the color.
All three areola tattoo artists expressed the crucial importance of aftercare for their clients. Dunsmore advises the use of antibiotic ointment and a non-adhesive bandage for the first three days, followed by hydrocortisone. After four or five days, coconut oil or unfragranced lotion can be applied to encourage color retention.
The writer dedicates this article to her mother Donna VanNorman and aunt Carol Kelly, both of whom she lost to breast cancer far too early in their lives.