December 2012 Plastic Surgery Practice

By Rose Marie Beauchemin

Today’s 3-dimensional areola complex tattooing looks so real, you have to touch it to believe it.

Up until approximately 5 years ago, most breast cancer survivors opted for nipple grafts. If women did not see the protrusion of a nipple, they seemed to feel incomplete and less feminine. Women shared their disappointment if the nipple grafts flattened or did not have enough definition.

Times have changed, and today more and more women are choosing 3D areola complex tattooing to complete their breast reconstruction, and there is also a pronounced increase in the number of plastic surgery groups requesting training in these highly specialized techniques.

No More Surgeries

There are many reasons for the paradigm shift. For starters, women can avoid an additional surgery by choosing 3D tattooing. Women often consider the nipple/areola complex to be quite sensual and sensitive. Following a unilateral or bilateral mastectomy, women not only lose sensitivity, but also tend to focus on the residual scarring on the unfamiliar, reconstructed breast mounds. This desensitization also affects their feelings of femininity, sexuality, and sometimes their overall perception of themselves.

Fortunately, today’s breast reconstruction surgeries, including the techniques used in creating nipple grafts and areola tattooing, create a most realistic and convincingly natural appearance. Yet, I still find that countless women who have undergone a mastectomy possibly grouped with chemotherapy, radiation, expanders, and implants often go several years with a bare, incomplete breast mound or mounds because they could not elect or endure one more surgery that wasn’t absolutely necessary. Regardless of the type of reconstruction, these women simply don’t have the energy required to elect a nipple graft procedure or tattoo that would so beautifully complete their newly constructed breasts. To quote so many of my clients, “I just couldn’t do one more thing!”

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Before

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After 3D areola tatooing

As a result, they do everything to hide in the presence of their spouse or significant other, and many avoid mirrors completely when disrobed. They remain feeling unfamiliar and unfeminine, disregarding the beautiful reconstruction created by the plastic surgeon. I say this because when I tell them how beautiful their surgery is, they respond by saying, “It is?”

Sadly, it doesn’t end with the reconstruction. The finishing touch to breast reconstruction is the nipple, and without it they feel incomplete.

Laser Tattoo Removal Improves with Age

While areola tattooing is improving the quality of life for many breast cancer survivors, laser tattoo removal is also big business. Even daytime talk show host Kelly Ripa has “tat regret” and is currently having laser treatment to get rid of a snake with a rose tattoo on her ankle.There’s good news for Ripa and others who want to get rid of signs of youthful indiscretion. Laser tattoo removal is getting better and better every day, according to two studies published online in the Archives of Dermatology.

In one study, a Q-switched laser successful removed tattoos for 47.2% of participants after 10 treatments and in 74.8% after an additional five sessions. The tattoos had been in place for about 4 years, had a median size of 50.5 cm2, and were most commonly located on the trunk or extremities.

Certain factors increase the chances of success, including not smoking and the use of black or red ink only. In addition, better outcomes were seen when the interval between treatment sessions was longer than 8 weeks, the new study showed.

And in a second small study, treatments with an experimental picosecond alexandrite laser also yielded high success rates.

According to the American Society for Aesthetic Plastic Surgery, there were 40,801 tattoo laser treatments performed in 2011.

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Erect Nipples Be Gone

3D areola complex tattooing also helps women avoid one of the more vexing side effects of nipple grafts—erect nipples that protrude through clothing every minute of every day. In the case of a unilateral mastectomy, the 3D tattoo is still a great concept to apply to the reconstructed breast since the nipple graft may remain more erect than that of the opposing breast. Protruding nipples force many women to wear a bra of significant thickness in order to hide their nipples when they don’t require a bra at all due to their reconstruction. They tell me that thinner fabrics, typically used in tank tops or camisoles, cannot be worn without a thicker or padded bra. In some women’s blouses and tops, a shelf bra is actually part of the garment, and this would typically be ample support for reconstructed breasts, but women with protruding nipples cannot wear this comfortable bra-substitute without a thick bra to hide their erect grafts.

3D Technique Demystified

The 3D nipple/areola tattoo is created using simultaneous contrast. Light, dark, and the absence of color in specific areas create this realistic effect. One option is to leave the center of the supposed nipple a light pigment, and tattoo the sides of the nipple in the darkest color. A slight halo is then left around the nipple perimeter, and the areola is tattooed lighter than the sides of the nipple.

Another option is to begin with the center of the nipple being dark, then this 3D effect can be achieved with various needle groups utilizing pointillism or a circling technique. The results are so profoundly realistic that we often hear from our clients that their husbands, doctors, and friends had to touch the tattoo to be convinced that it is not actually a protruding nipple.

Selecting the best pigments for the client’s skin tone is very important. One application, or possibly two at most, will last several years. This is a pain-free procedure—very few clients require a topical anesthetic.

3D areola complex tattooing is an excellent option for many breast cancer patients because of the realistic appearance, painless procedure, and lack of hassle and healing time. Being able to perfect this technique and provide it to women who are truly in need of a confidence boost in their own femininity has provided me with immeasurable joy as I share in the empowerment and life-changing moments with my clients.

Rose Marie Beauchemin is the founder of the Beau Institute in Mount Laurel, NJ. She is a founding board member and diplomate of the American Academy of Micropigmentation and a Certified Permanent Cosmetic Professional by the Society of Permanent Cosmetic Professionals. She can be reached at PSPeditor@allied360.com.