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A woman faces the bathroom mirror. The scar cuts through the reconstructed left breast, spanning the width of it. The nipple is gone. Her left side is as smooth and unfeeling as a Barbie doll’s. It doesn’t look like a part of her.
Cancer was no one’s fault. But she thinks back to sticking her iPhone in her bra for safekeeping and wonders if that did it. She thinks of her grandmother who had a double mastectomy at 54 and wonders if it was just in her blood. Could she have prevented all of this? Or was it only ever a matter of time before a routine annual revealed the small lump in her left breast? She is more than her silhouette in a favorite dress. She is more than what she has lost. She wants her life back, but some days she just doesn’t feel beautiful anymore.
Following a mastectomy, women—and a few men—face many roads to healing. According to breastcancer.org, about 56 percent of women chose reconstruction, a process that can include 3D nipple reconstruction. Creating the illusion of a nipple and areola is not as simple as choosing the right color; tattooing techniques used by most surgeons are notoriously prone to fading, and skin that has been irradiated (exposed to radiation) can be difficult to predict. Even the cleanest surgical job with minimal scarring can be ruined by a bad areola tattoo and most surgeons only do one color. The result favors utility over beauty.
After their lives are saved, many women, healing from the trauma they have undergone, are left wanting a more realistic breast than their surgeons can provide. That’s where tattoo artists step in.
“Most of my clients have never had a tattoo before,” Marie Sena explains. She works with a tight network of local oncologists, surgeons and breast surgeons who refer clients to her. “A lot of them come in and say, ‘Just help me get it back.’”
Marie and her husband own Electric Eye, a tattoo shop on Jefferson Boulevard in Dallas. Tattoo sketches of pinup girls, flowers and Tasmanian devils pepper the brick walls. An astounding number of medical renderings of the human body are on display, both in the main waiting room and the lofted nook. Up there, Marie sketches at a worktable as she listens to the calm, orchestral soundtrack from The Assassination of Jesse James by the Coward Robert Ford. Animal furs rest on tables. Unidentifiable embalmed objects float in jars by the window. It feels as if the building used to be an old-time apothecary and they forgot to redecorate.
Marie has inked almost all of her skin, from soft gray roses on her shoulder to a galloping, decorated horse on her thigh. But her strangest tattoo has to be the rudimentary pink shape on her leg. It’s unmistakably a nipple—the first nipple she ever tattooed.
“There was no set path to do this; I had to figure it out,” she reminisces as she draws a breast on paper freehand. “I did four practice ones before I worked on someone who needed this kind of work because I didn’t want to mess around. I did this little nipple on myself. My husband has number two; a friend has number three. I needed to know how to do it.
Marie is one of many tattoo artists around the country who provide a much-needed service for women after breast cancer.
“My undergraduate degree is very obscure: Biological and Pre-medical Illustration. Basically, anything in the realm of scientific and natural illustrations,” she laughs, “but no one will pay you to do that anymore.” Her tiny class was encouraged to go to graduate school for medical illustration, which was how she ended up in Dallas at UT Southwestern Medical Center getting her master’s degree.
“Graduate school was essentially the first two years of med school, just without the clinical stuff, in addition to illustration classes. There’s not a lot of room for error, because we’re doing the illustrations that are instructing the public and medical professionals,” she explains. Her first contracted gig as a medical illustrator was for OB/GYN textbooks. One of her advising doctors pointed out that Marie’s skillset was incredibly unique: a trained medical illustrator well-versed in clinical situations and a tattoo artist. She suggested that Marie look into areola tattooing.
“I started researching what happens after reconstruction surgery. I was very motivated to do something better for them.”
Like a painting, a realistic areola tattoo is achieved by creating an illusion. Nipples are not one solid color. There is variation from body to body. Her hardest job is usually matching a reconstructed nipple to an untouched one, knowing how it will heal and how scarred and irradiated skin will hold the pigment. One client—an anomaly—came to Marie to fix an areola tattoo that was little better than a messy circle that bled over the edges in lurid, shiny pink.
“A real nipple is a little redder than the surrounding skin. I add a little shadow, a little emphasis.” She has taken areolas that looked like flat rubber baby bottle caps and tightened them up, adding shadow and depth of color, turning them into masterpieces marked with tiny, individual details. Marie sees it all.
“I also do scar camouflage for women who have had flaps—if you don’t have enough skin to recreate a breast, skin is taken from somewhere else and grafted on. But if you’ve had radiation, there can be a huge color change.” She shows me one picture of a client whose flap was radically paler than the rest of her chest and extended up toward her collarbone. Over two treatments, Marie tattooed the whole breast until the scar was invisible, seamlessly blended.
Occasionally one of her clients will pay it forward, covering the next woman who comes in. Marie describes it as a magical, serendipitous experience every time. “It’s guaranteed that when someone pays it forward, the next person needs it. It saves their butts. Every time.”
Insurance companies are supposed to cover these procedures but consider tattoos cosmetic. All too often women have to fight to get their post-mastectomy procedures covered. They end up mired in legal wars after being drained emotionally and financially in a battle for their lives. Tattoo artists like Marie, as much as they might like to help, can’t do every tattoo pro-bono or they won’t be able to make a living. That’s where nonprofits step in. P.ink.org, for example, raises funds to pay tattoo artists who do these procedures so that women who have already survived breast cancer can get work done without having to pay a dime. P.ink’s waiting list is currently over 1,500.
Marie isn’t the only tattoo artist offering these services. Vinnie Myers is a well-known artist who travels with his team—he sends two team members to Dallas bimonthly—and has done funded procedures for thousands of women.
Local people have also found ways to support these women. Prosper-native Nate Mayberry, founder of Seal the Deal tattoo cream and a tattoo enthusiast himself, made funding these tattoos the primary mission of his business.
“Maybe I was just a naive man, but I didn’t really understand what women go through,” Nate admits over a Little Pink Drink at Starbucks. His perspective changed when his sister was diagnosed with breast cancer. She had to have a double mastectomy followed by reconstructive surgery that included 3D nipple and areola tattooing. Her insurance company fought her every step of the way.
“Maybe they want tattoos to cover the scars, to feel whole and beautiful again—I can’t speak for them because I’ve never been through it,” he says. “But my sister said she wanted to feel like she was a woman again. [Her tattoo] helped her begin to heal.”
By the time a client gets into the tattooing chair, they have already won. The worst is over. To Marie, her stage of the process is the happy, healing stage. As for more elaborate breast tattoos, Marie sees many women who are self-conscious about extra scarring, or want to go nuts and get something beautiful to commemorate their survival. She shows us a spray of purple and pink flowers that she painted triumphantly over one woman’s chest.
“I almost always do that free of charge if I can, because why not? They’re already here. And a lot of them have never had a traditional tattoo before,” she says. “It’s an exciting experience for me too. They feel badass. They come in a little nervous, and they leave happy. We have a good time, and I feel like I did something really good to help this person get their life back. It’s not one size fits all,” Marie explains. “It’s a specialty. It’s the most important thing I’ve ever done.”
Over the years, tattoos have become mainstream. They aren’t associated with gangs and violence but with personal expression: from a butterfly on an ankle to detailed sleeves that require decades of work. For women who have had mastectomies, a realistic areola tattoo can make them feel whole. Sometimes a woman just wants to look like herself again.