Areola Tattooing

If you are considering areola tattooing as a last step of breast reconstruction, we at The University of Kansas Health System can help make sure you feel confident and informed about your procedure. Here, you'll find information that may help you make a decision about whether this is the final step you want to take in your breast reconstruction.

Some people find this technique is an important step in their breast reconstruction process. Other people decide they don't need this step. The choice is individual and doesn't need to be made immediately.

Areola tattooing is a cosmetic procedure that creates a "picture" of an areola and nipple on the breast. The tattoo will look 3-dimensional but it is flat to the touch. If a woman chooses to have areola tattooing, it is the final step of breast reconstruction after a mastectomy if the nipple was removed as part of the surgery.

It involves tattooing a nipple on the skin that may have details that make it look more realistic than a nipple reconstruction might. It may also be able to cover scars from the breast reconstruction surgery. Areola tattooing is a less invasive alternative to nipple reconstruction surgery. It can also be used to add color to nipples after nipple reconstruction surgery if you have chosen that.

If you have had breast reconstruction with an implant or tissue flap, you may be a candidate for areola tattooing. Women and men who have had breast reconstruction surgery after breast cancer or for another reason may be able to have areola tattooing as the final step in their reconstruction.

You may not qualify for this procedure if:

• Radiation treatments damaged your skin
• Your breast skin is overly thin because of tissue removed during your mastectomy
• You have lymphedema that involves the chest
• You have a history of infections in your breast area

If you aren't sure areola tattooing will work for you, discuss it with your plastic surgeon. They will be able to help you decide what will be best for you.

Areola tattooing works the same as getting a regular tattoo. A tattoo artist will tattoo a 3D nipple and areola on your reconstructed breast. You will need to wait 3-4 months after breast reconstruction surgery is complete to schedule an appointment for your areola tattoos. The skin and scar tissue need to be healed enough for the tattoo artist to complete the tattoo. The appointment will take place in the office and should take 1-2 hours.

Areola tattooing is an alternative to nipple reconstruction if you don't want to undergo another surgery. Healing and recovery after a tattoo is easier than that of nipple reconstruction surgery.

Some people like the results of areola tattooing better, as well. They may feel that the details, coloring and shading look more realistic. Some women particularly like that the tattoo is flat, so they can choose not to wear a bra and their nipples won't show through their shirts.

As with any tattoo, there are risks to getting an areola tattoo as well. These risks include:

• Allergic reactions
• Infections
• Granuloma, which is a small area of firm inflammation
• Additional scarring

A tattoo artist who is specialized in this type of micropigmentation will mix colors, working to match them to your coloring. If you have 1 of your natural nipples, they will create a tattoo matching the size and color of the nipple and areola as closely as possible. If you had a double mastectomy and can provide original photos, the tattoo artist will match those colors.

The artist will apply the tattoo using needles that insert pigment into your skin. About 95% of women have no sensation after breast reconstruction, so you likely won't feel much during the tattoo process. On occasion, some people may feel a little discomfort. If there is pain, topical anesthetics may be used.

After the tattoo is complete, it will be be covered with a protective dressing and you will be given specific instructions about how to care for the area. You will want to avoid chlorinated or salt water for some amount of time and you will want to make sure you don't let your tattoo scab over.

Your tattoo will naturally fade a little bit as it heals. Any cleansers you use may also affect its fading. You will want to have your tattoo refreshed sometime between 6 months and 2 years later. Following the care instructions you receive will help the tattoo heal faster and prevent excessive fading.