Tattooing may be used for medical purposes. Dermopigmentation is a form of medical tattooing, a complementary technique used to reconstruct the nipple-areola after breast cancer treatment. Nipple tattoos are an increasingly popular choice among women who have undergone breast reconstruction after surgery (post-mastectomy reconstruction). A nipple tattoo is usually straightforward from a technical point of view. Studies confirm this type of procedure can reduce the psychological impact of physical changes following surgery.

It was Marianne’s plastic surgeon in the Netherlands who first mentioned the option to her, after her mastectomy several years ago. She was in her forties. ‘After everything had healed well after the operation, I felt ready to consider breast reconstruction. I decided to go for a prothesis, an implant under the skin. There were various other possibilities, using skin grafts from other parts of my body, but I did not want any more scars. For the implant, space had to be gradually created and during this process the plastic surgeon mentioned he would form a nipple, and an areola could be tattooed.

Did it take you long to decide? Did you have any particular views on tattoos?

For me it was fine. I did not have any specific opinions about tattoos. As far as I am concerned everybody is free in their choices. This tattoo for me was completely different than a picture on your skin. This is medical tattooing which, I knew, would help me.

What steps did you have to take? Were you referred, could you choose the tattoo artist?

I was referred to someone specialised in medical tattoos in a skin therapy centre in Leiden, where I live. She was employed by this centre, but also had her own practice in a different town. This tattooist told me she would create an artistic representation of an areola and showed me photos with examples. I completely trusted her. She assessed the colour and structure of my skin and came up with a design proposal. She would place dots in various colours, for a realistic looking shadow around the skin edge the surgeon had created as a 3 D nipple. The tattooing was done over several sessions. The costs were covered by my health insurance.

What do you think of the result? Would you choose this option it again?

I am very happy with it. I am still very happy with my new breast and the very realistic looking areola. Before, it was a lot of hassle with the initial loose prosthetic. Leaning forward in a top with a low neckline, or lying on your front in a bikini, the prosthetic would fall away from my chest so you would see the gap between the prosthetic and the scar tissue. And showering in the gym I always felt the need to put other people at ease, because the amputated breast might shock or surprise them. Now, I don’t think twice about being topless on the beach. So yes, I am really pleased with the result. Over time, my tattoo has faded a bit, may be I will consider a touch up and that’s no problem. To others having to make this choice I would like to say: go for it.