Few people realize how long and complex breast cancer treatment is. The Komen Foundation and Avon rarely highlight post-surgery debacles in their fundraising literature, and the visceral reality of scars is seldom discussed unless being celebrated. As the model Matuschka showed in her 1993 photograph and more recently anthropologist Lochlain Jain in her bio-ethnography Malignant, baring scars for public consumption (whether on a NYT magazine cover or in a yoga class) is powerful.
However, for those who keep their scars covered, who avoid looking and hide their chests from lovers and loved ones, the option of reclaiming that part of their body is powerful. Some do so by opting for post-surgery breast reconstruction. Depending on the effects radiation has had on the skin and the type of breast cancer surgery undergone (e.g. mastectomy, lumpectomy, or nipple conserving), breast reconstruction options might include insertion of an ‘expander’ followed by an implant, a ‘flap’ (often described as a tummy tuck because the fat for the reconstructed breast is taken from the belly area), or reattachment of the nipple. In my research with safety-net breast cancer patients over the years I have repeatedly listened to stories of surprise at the pain and unanticipated results of reconstruction. Breasts sag unexpectedly over time, nipples fall off, and implants have to be replaced causing repeated trauma in the face of another surgery. Some women have two or three separate surgical procedures to reconstruct the breast completely. Many are exhausted by all the surgeries and refuse to return to the operating table for the final stage of nipple reconstruction. In an average year at one of the public hospitals where I conduct fieldwork, for example, approximately 40 breast reconstructions are performed, with a very small proportion (one ninth) including nipple reconstruction.
Over the last two years a medical oncologist, a program coordinator, and a tattoo artist have been collaborating to provide another option to women in Northern California. With support from San Francisco General Hospital and the Plastic Surgery Foundation, they have worked with 41 women to complete their breast reconstruction non-surgically, via 3D nipple tattooing. Working in a spa-like atmosphere in a downtown San Francisco penthouse, Sasha Merritt of Dragonfly Ink meets with women, talks them through the process, and paints nipples on breast mounds crosscut with surgery scars. She matches each woman’s skin pigmentation with her custom-mixed ink, and uses light and shadow to tattoo nipples that look just like the real thing. I’ve been interviewing these women about their experience of tattooing over the last several months. Cynthia (a pseudonym) had had her first breast cancer surgery in the 90s and her second just a year ago. She agreed to undergo tattooing “just to see.” She had avoided looking at her breasts for years and found the initial meeting with Sasha pretty painful. Sasha kept asking her to look at her breasts as she added color, adjusted tone, and Cynthia just didn’t want to look. But she did. And she was astounded. They looked like what she remembered. She felt warmth and compassion for her breasts again, something she hadn’t felt for years. Aubrey, a 32 year old, told me how she broke down during the first visit with Sasha. She loved the idea of a tattoo on her breast, but thought it should be a butterfly or something, not a nipple. Trying to make herself normal again, she felt, wasn’t authentic to who she had become since her breast cancer diagnosis. But when Sasha started the painting she felt it was somehow right. And, the tattooing process reminded her that she could feel sensation again. Now she pulls up her shirt to whoever wants to see, and dating has become easier.
Well done 3-D nipple tattooing is pretty rare, and the two artists featured recently in media reports live on either coast. The going rate is out-of-pocket $900 to $1500. Sasha Merritt was able to provide the service for free, thanks to grant funding that has now ended. The Women’s Health and Cancer Rights Act of 1998 requires coverage for post-breast cancer reconstruction, but Medicaid and Medicare don’t cover nipple tattooing (Medicaid will not cover tattooing of any kind). Sasha is attempting to address these gaps in the system by providing training to breast cancer surgeons on 3D tattooing. However, as a breast cancer surgeon stated when counseling Susana through her decision to go see Sasha, “I could do it [tattoo the nipple], but I’m a surgeon, not an artist.”
Nancy J. Burke, Associate Professor
UC Merced, School of Social Sciences, Humanities, and Arts