For breast cancer survivors, it can sometimes be triggering, dysmorphic, or otherwise upsetting to have to undergo breast reconstruction surgery, also known as a mastectomy. To repair a sense of normalcy for those who want it, it's possible to get an areola tattoo, which reconstructs the way your nipple looks with pigment to make it appear more natural and realistic.
We spoke to Shaughnessy Otsuji, owner of Studio Sashiko, about this special ink.
What is an Areola Tattoo?
An areola tattoo is a cosmetic procedure that is done on the area of the breast or chest where the areola is found. The idea of areola ink is that it alters the appearance of the nipple in some way, be it adding one or changing the shape. Areola tattoos are done in the same manner as other tattoos—by depositing ink under the skin to create a permanent image—but tend to be particularly detailed in regards to blending and feathering, to ensure an extremely natural look.
Why Would You Get an Areola Tattoo?
An areola tattoo essentially creates a new nipple, and there is one particularly powerful reason the procedure is done: to help breast cancer survivors be comfortable in their bodies post-surgery. Many cancer survivors undergo breast reconstruction surgery (or a double mastectomy if both breasts are affected), but still don’t feel comfortable in their bodies after all they have to endure. That’s where areola tattoos come in: they’re a great way to help women construct the bodies they want to boost self-confidence and help them feel natural in their own skin. It’s also a great alternative to nipple reconstruction surgery for those who want something a bit quicker and easier.
It’s important to note that areola tattoos aren’t just for survivors who have undergone breast reconstruction surgery and had their nipple affected. If you had surgery that left the nipple intact, you may have scars or misshapen areola. These issues can be easily visually improved by tattooing over them to even out the shape, size, and color of the nipple.
"This type of tattooing offers so much healing for someone who has experienced a drastically altered appearance," says Otsuji. "Being able to reconnect with your previous self when you look in the mirror is a magical thing!"
While areola tattoos are a fantastic resource for breast cancer survivors, it’s also totally appropriate to get the ink for other reasons. Some people like to change the shape or color of their nipples with ink, and it allows you to have full control over how a part of your body looks.
"I work with trans and non-binary clients who have received top surgery and reconstruction; clients who have burns, skin grafts, or other scarring that has affected their chest; as well as anyone who is unhappy with their natural nipples and may need reshaping or re-pigmentation," says Otsuji.
How to Find an Artist for an Areola Tattoo
Because areola tattoos are such a specific kind of ink—and because they are on such a sensitive area—it’s imperative that you find an artist who not only has experience in tattooing or cosmetic tattooing, but who is also fluent in this exact type of tattoo. If you’re not sure where to start and know someone who has gotten an areola tattoo, ask them for their recommendations. If you don’t know anyone with the ink, you could try reaching out to a local breast cancer group or center for suggestions. Another good resource for finding an artist is Areola Restorative Tattoo (ART), a global collective of experienced and advanced tattoo artists who specialize in permanent areola and restorative tattooing. Some dermatologist or doctors’ offices also offer the procedure; even if they don’t, they’d be happy to suggest artists so you know they’re high quality.
Once you find a tattoo artist that you feel like fits all of your qualifications, make sure to check out their work online to make sure the style lines up with what you want. Experienced artists should have a portfolio of areola tattoos with both the before and after photos, so be sure to look online for it or ask the artist directly if it’s not public (which it may not be, due to the nature of the body part placement).
The prep work doesn’t stop once you find an artist, though. Make sure that you meet with them for a consultation to discuss what you want the areolas to look like, for the artist to get a sense of the condition of your breast in terms of scarring and skin texture, and to go over any other details that need to be ironed out before the process begins.
Although there may not be much in common between eyebrows and nipples, areola tattoos are performed similarly to eyebrow microblading. An experienced medical tattoo artist will first work with you to design an areola tattoo that looks exactly how you want, as each areola tattoo is completely customized to you, says Otsuji.
"During this consultation, we’ll discuss the client’s desired nipple size, placement, and pigment colors that complement their skin," says Otsuji. "I’ll also want to assess the client’s skin type and any scar patterns or scar tissue that may require more technical skill to achieve the end result."
When a design is agreed upon, the artist will then use an oscillated tattoo needle covered in non-toxic color pigment to insert the ink below the outer layer of the skin. While the actual nipple isn’t being reconstructed, the image of it will appear that way when done by an experienced medical tattoo artist. Otsuji notes that, in most cases, skin can be quite thin, scarred, and delicate after surgery, so it's important to find an artist who understands the gentle touch needed.
How long the entire tattooing process takes is up to a number of variables, including your artist, the demands of the new areola design, and the condition of the breast. Because a mastectomy often leaves scars and roughly-textured skin, the procedure would have to be crafted around keeping you and your actual skin safe. This means the entire process could take anywhere from 30 minutes to multiple hours per breast—you’ll have to check with your tattoo artist to get an accurate estimate of how long to expect, though Otsuji notes the process generally takes about two to two and a half hours.
Your tattoo artist will apply a dressing of some sort to your areola tattoo after it’s complete, and it’s important to keep a close eye on what you do with it on. Be sure not to get the covering wet, as this could affect the pigment or even possibly cause infection. It’s also necessary to keep your fresh ink covered for at least a day, as it may continue to bleed.
To ensure your areola tattoo heals perfectly, be sure to keep the area dry and clean. You’re allowed to take a shower or bath 24 hours after the procedure, but you cannot use soap on the area or submerge it in water. While you shouldn’t wash the new tattoo, it’s recommended to apply an antibacterial ointment or another product directly suggested by your artist to keep the areola from drying out and over over-scabbing. Also avoid sleeping on your stomach and touching the pigment to avoid irritating the area or even causing an infection.
Healing Time and Pain Level
Your areola tattoo will take, on average, 10-14 days to heal. This isn’t a set timeline, though, as the condition of your skin will ultimately affect it the most. A healing piece of areola ink will go through three stages in the weeks following getting tattooed: healing, peeling, and lightening.
In the healing stage of the aftercare process, your new tattoo will finely scab over to protect the area while it heals. Then comes peeling, which will cause those scabs to fall off once it heels. Do not pick the scabs! If you don’t let them naturally fall off, you could cause pigment loss and damage to your new tattoo. Finally, once all the scabs are fully gone from the tattoo area, you’ll notice the ink will appear lighter and more natural.
If you’re looking at getting an areola tattoo as a breast cancer survivor, pain may not be something you have to worry about. It’s extremely common for mastectomies to lead to breast numbness, as the procedure purposely causes nerve damage to reduce sensation. You may experience tingling or feel uncomfortable, and if you have an implant, you may feel it vibrate throughout the session.
"The majority of my clients experience loss of feeling in the area after their mastectomy due to tissue removal and nerve damage," says Otsuji. "This actually works out well for tattooing an area that would normally be very sensitive!"
If you go for an aesthetic areola tattoo, though, you can expect a lot of pain due to the typical sensitivity of the area.
How Long Will an Areola Tattoo Last?
Although areola tattoos are permanent, it’s technically a form of cosmetic tattooing, which is slightly different from traditional ink. Instead of creating a visual on your skin that stands out, the goal of cosmetic tattooing is to alter the body in some way to match your natural look and create an essentially unseen piece.
Cosmetic tattoos also tend to have less concentrated pigment than traditional ink, so your body will metabolize it quicker. This will ultimately lead to fading, though it will happen over time, not overnight. Expect to see noticeable fading years after first getting inked; however, this depends on your metabolism and skin condition, so there’s no way to give a true estimate of how long the tattoo will look fresh. Be sure to avoid irritants like chlorinated or salt water, harsh cleansers, aloe vera, Retin-A, or glycolic acid, as these could cause your areola tattoo to fade more quickly.
Side Effects of Areola Tattoos
It’s completely normal to experience slight swelling and redness after the tattoo, and you may feel like your skin is “tight” or pulled taut. Scabbing and flaking is also to be expected, so don’t be alarmed if your healing ink looks patchy or feels hard to the touch.
As with any tattoo, there is always the risk of side effects. The worst case scenario is your areola tattoo becoming infected, which could cause more swelling, prolonged redness, and pain. Keep an eye out for less common symptoms like fever and muscle aches as well, as these are signs that something is going wrong in the healing process.
And if you’re considering an areola tattoo as a survivor of breast cancer, you can rest easy knowing that the ink does not increase the risk of cancer reoccurrence (or occurrence, for that matter). If you’re undergoing radiation, however, it’s suggested that you refrain from getting inked until the process is complete.