The final step in breast cancer reconstruction, if you so choose, is the nipple and areola tattoo. You’ll need to wait a good 6-8 weeks after your nipple surgery to have your tattoo. I was anxious to get it done sooner, but am so glad I waited until my new nipple was totally healed. Having now completed this step, here is what to expect, as I had no idea what was in store for me.
STEP ONE – Color Matching
The first thing that happens is the PS gets what I’ll call “paint chips” and holds them up to your natural breast (again, I still have one breast for color matching so this could be done). You can do this step prior to a mastectomy and record the color for later reference. Dr. Ferlmann explained that he’ll be blending colors to reach the optimal shade – the areola is much lighter than the nipple. My PS was thankfully very fussy at this step and tested colors, leaving smears of color on the skin next to my good nipple to see which was the best match. Once he was satisfied, it was time for step two.
Footnote: Talented PS can make a 3-D tattoo. If you want to forgo the minor surgery of constructing a nipple, you can opt for a 3-D tattoo!
STEP TWO – Making the Template
Dr.Ferlmann drew around the perimeter of my natural areola with a blue marker, then blotted the area carefully onto a paper towel. Magically, the paper towel absorbed the image, which my PS carefully cut around with his scissors, poking a hole in where the nipple comes out. He then flipped the image and slipped it neatly over my surgically created nipple (fully healed) and drew around the perimeter with the same blue marker. He was careful not to draw it too perfectly, as he felt that would not look normal.
STEP THREE – Tattooing
At this point, Dr. Ferlmann asked me if I would like a lidocaine shot for the pain. Pain? I wouldn’t think a tattoo would hurt…I’ve seen people getting them on TV and they described it as “uncomfortable” and heck, much of the feeling in my left breast was gone anyway, so I said no. Part way through, I asked my PS to stop. It DID hurt and I wanted the lidocaine. I was avoiding the shot, not to be macho, but because I truly thought I wouldn’t feel the pain and because there is a slight risk that the needle would penetrate my implant, causing what I’ll call “a flat tire.” My pain was actually a good thing, said Dr. Ferlmann, as it means the nerves are regenerating in my breast and sensation is more likely to return. Ah, so pain IS good!
So, Dr. Ferlmann obliged to my request for pain shot (and felt better as he said he can’t watch for me to grimace AND do a nice tattoo). As you may know, pain shots many times hurt worse than the pain itself and I could feel the multiple shots, but about 30 seconds later it was all much better and he could get back to work. The tattooing part only took about 15 minutes – he used the machine pictured above. The stylist looked similar to the wood burning pen we used in Cub Scouts with the boys, but I’m sure it was a lot more expensive! It is designed with many needles that cannot penetrate the skin to a depth that would damage or rupture the implant (good to know).
STEP FOUR: Bandaging
Little did I think of a tattoo as a minor surgical procedure, but yes, there is blood. And because of the now hundreds of needle pricks that created my new tattoo, there is a change of infection, I wore a sterile gauze pad for one week and followed up with my PS in 10 days to make sure everything had healed and nothing needed to be touched up. No shower for 24 hours and change the bandage daily. Daily routine of: apply antibiotic ointment to new tattoo, cut to size a sterile petroleum-based non-cling sheet to cover area, then cover with sterile gauze pad, and tape into place. So much for my preconceived notion of a tattoo being simple and painless, but at least it is over now.
So that is the final step of breast reconstruction. One last visit to my PS and I was released from his care. I thought about my journey through DCIS on my 15 mile walk to this tattoo appointment, but that’s good fodder for another blog in the near future.