This story is part of Survivor's Guide, a series on navigating the impact of breast cancer through beauty and self-care.
Over the last 10 years, nipple and areola reconstruction for people who've been through breast cancer treatment has advanced greatly. In addition to surgical reconstruction, cosmetic tattooing has become a more popular choice for those who have undergone a mastectomy (removal of the entire breast). Nipple-areola tattooing is a type of reconstruction that involves tattooing a nipple on the skin and adding color and shading in such a way that it looks three dimensional and hyperrealistic.
A nipple tattoo is similar to a regular tattoo because it's permanent, but it’s also different because "you are working on compromised skin," artist Vinnie Myers — who, to date, has tattooed nipples onto nearly 12,000 women — previously told Allure. It's imperative to find a trusted artist with a portfolio and to have a discussion about color, size, and the overall look advised Myers. "Ultimately, these should be your decisions because they are staying with you forever."
While medical records of successful mastectomies date back to the late 1800s, nipple and areola reconstruction only started to become common in the 1980s. It wasn't until the late '80s and early '90s that medical nipple and areola tattooing gained popularity. More recently, non-medical tattoo artists have started incorporating it into their practice — and some medical facilities have started hiring or working with more tattoo artists specifically for these types of reconstructions.
Cosmetic and medical tattoo artist Mandy Sauler has been practicing nipple-areola tattooing for the past nine years, and currently works with Penn Medicine’s Ruth & Raymond Perelman Center for Advanced Medicine in Philadelphia. She also founded Sauler Institute of Tattooing, where she trains tattoo artists and medical providers. She focuses on the entire reconstruction process and offers patients the post-mastectomy option of nipple-areola tattooing.
To understand how these procedures work, it's useful to know how nipples are naturally structured. Although many people think of the nipple and areola as one entity, they're actually two separate ones. "It's the nipple in the center and the areola on the outside," Sauler explains.