There are many milestones throughout a cancer journey. 

For some, that can include closing the chapter on breast reconstruction with 3D nipple tattoos. 

“We realized that the nipple tattoo was always an afterthought,” said Crystal Yang, RN, co-founder of Perky, of her time working in reconstructive surgery. 

Perky, which Yang runs alongside Courtney Delago, RN, is a San Antonio, TX-based medical aesthetic clinic that specializes in 3D nipple tattoos for people impacted by breast cancer. 

“Women need more support in their survivorship to help close some doors,” said Yang. “We understand that survivorship is a journey—a lifelong experience—and Perky was needed in this realm to provide more support and really good nipple tattoos.”

What are 3D Nipple Tattoos?

As opposed to nipple reconstruction, which is a surgical procedure that uses skin grafts to recreate a nipple bud, 3D nipple tattoos replicate the look of nipples by using shading techniques to create depth on a smooth surface. 

“We loved the artistry behind the highlights and the shadowing,” said Delgado.

These techniques, however, are not mutually exclusive: you can choose to do both, one, or neither. For example, someone who has had nipple reconstruction can still opt for a 4D nipple tattoo to add back the color and shape of an areola. 

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While this technique can be especially helpful for those whose nipples and areolas have been removed during non-nipple sparing mastectomies, the tattoos can also help even out the appearance or restore the shape of those that were saved but still impacted during surgery. 

“We customize everything to each client so it’s what they want: the details, color schemes, the aesthetic vibe they’re going for,” said Yang. “No nipple or two nipples are the same.”

What Makes Medical Tattoos Unique

Yang and Delgado explained that nipple tattooing presents unique challenges because of the canvas the artist is working on. Factors like scar maturity and residual swelling can impact the final results, Delgado said. 

That’s also why Yang said it’s important to “keep their medical providers in the mix.” Questions she suggested someone ask their care team can include: “What is the timeframe that they want you to wait? Do you still have active treatments that need to be completed first? Does your body need to recover, recuperate, before you get the tattoo?”

An artist who is informed in breast reconstruction should be able to pay attention to those signs of healing and make recommendations, such as manual lymphatic drainage, “before you have your tattoo, so you can get the best result, hold the ink, and not waste your time and your money,” she said. 

“ I want to make sure [my patients] happy with their results before they do nipple reconstruction [or tattoos],” said board-certified plastic surgeon Dr. Nneamaka Nwubah, who goes by Dr. Amaka. 

She explained that revision surgeries can change the position of the nipple and that she typically advises patients to wait about six months after their final surgery before moving forward with tattoos. She said this would give time for implants to settle, for example, and to ensure that there aren’t other complications, like capsular contracture. 

Beyond the physical healing, Yang and Delgado also stressed the importance of being emotionally prepared to take the next step. Delgado shared that she’s had clients who’ve waivered on their decision and canceled appointments. 

“If something’s telling you [not to go for it,] you have to go with your gut,” she said. “Just take time and we’re here when you’re ready.”

How to Find the Right Tattoo Artist for You

If you’re in the market for a nipple tattoo artist, Delgado, Yang, and Dr. Amaka provided questions you can ask to make sure you’re in good hands:

• Have they worked on reconstructed breasts or people who have had breast cancer treatments, like a mastectomy, lumpectomy, or radiation?
• What do they know about working on or near scars to prevent additional or worsening scarring?
• What types of inks do they use? How do these inks hold up over time? Do the colors gray out as they heal?
• Can they show you healed results on someone with a similar skin tone?
• How many sessions might you need to get the results you want? Is the artist open to doing touch-ups or revisions later on? 
• Do they accept insurance?

For Breasties with darker skin tones, the Perky team recommends you look out for artists who avoid cooler undertones, as they tend to gray out over time.  

“Make sure they know how to pull in warmer tones and the right darker tones that aren’t going to ash out,” said Delgado.

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