On Tuesday, JAMA published an illustrated piece on the healing role of post-mastectomy tattoos, authored by David Allen, a Chicago-based tattoo artist. The piece was a change of pace from what medical journals traditionally produce.

Ten years working with breast cancer survivors has honed Allen’s technique, to which he brings a strong sensitivity. The period Allen spends with his client before applying the tattoo is as important as the procedure itself. “There’s a whole process behind this,” he says. “Part of it is empathy and composition and design. Part of it is just being able to be present and handle the amount of time with the person.

First, Allen and the woman chat so he can learn about her tastes and personality. Once she feels comfortable, he says, “We start to design. It may be as simple as they don’t like roses. Or it may be as complex as, ‘I want this specific area covered.” Together, they sit in front of a computer as he moves and edits design features onto the photographed breast.

Allen uses a particularly gentle tattoo application process for these clients, selecting fewer and smaller needles and using a quiet rotary machine to create organic, botanical imagery. The tattoo takes anywhere between two and six hours, depending on whether it’s a single or double mastectomy, and the scar’s size and surface area. Another consideration is how women handle pain. While tattoos in the chest area can be “pretty painful,” he says, one silver lining of cancer treatment is that nerve endings may be dulled, reducing discomfort.

Allen charges between $1,200 and $2,200 for a post-mastectomy tattoo. While it’s not the most lucrative work he does, given the time commitment, he values the opportunity to help women regain control and see something beautiful evolve from the trauma of breast cancer treatment.