Dr. Laura Reed on Nipple and Areola Repigmentation Q&A

Many women consider nipple tattooing – aka areola repigmentation, or Nipple Areola Complex (NAC) tattooing – as the final touch to their breast reconstruction following cancer treatment. However, like any medical or paramedical procedure, there are tricks to getting the very best, and safest, result. Dr. Laura Reed has been doing medical tattooing and permanent makeup for over 7 years and is one of the only of her kind in the country. She shares answers to some common questions here.

Q. What should you look for in a tattoo artist in terms of keeping yourself safe?

A. From a medical perspective, women must always keep in mind that the process of medical tattooing is an invasive procedure. The upper layer of skin (Epidermis) will be “broken” and opened to the extent that body fluids (blood and/or lymph) will travel to the surface.

A consumer can feel a false sense of security when told that, “new, sterile needles are always used.” However, using a sterile needle in between clients or patients is not enough to prevent cross contamination. It is imperative that ALL tattoo artists fully know and understand exactly what to do—and what not to do—to prevent or minimize body fluids from touching and contaminating surfaces. They must also know how to properly protect and disinfect surfaces that cannot be sterilized. They must know how to correctly sterilize any non-disposable items that may be used and also know how to properly maintain their sterilization devices such as an autoclave.

Nationally certified permanent cosmetic professionals and licensed tattoo artists follow strict guidelines established by the Centers for Disease Control (CDC) and Occupational Health and Safety Administration (OSHA). The CDC rules for preventing cross-contamination are extensive. They require thorough education and training to learn all of the detailed steps. The tattooist must then have enough practice in order to prevent mistakes, especially if she/he does not have any medical background.

Q. Is it Ok to get my nipple tattoo in a regular tattoo parlor setting?

A. When a woman is researching permanent cosmetic professionals, there are also practical things she should keep in mind in addition to the medically related screening factors. For example, a breast reconstruction patient should visit the facility where the procedure will be performed. If the artist works in a spa or salon, the patient should ask to see the room where areola repigmentation procedures are performed. It should be used exclusively for cosmetic/medical tattooing and nothing else (no hair styling, waxing, etc.). This is imperative if the city or state does not require health department inspections. The room should be extremely clean and preferably quiet and/or secluded from the rest of the salon (no smells, loud music or voices, etc.). The patient will be undergoing a very personal, invasive procedure with some possible discomfort. Every step should be taken to respect the woman’s privacy and make the experience as pleasant and comfortable for her as possible, as well as safe.

Q. Does a tattoo artist need to have specific experience in micropigmentation to do a good job?

A. Yes. But most people ask, “How long have you been doing micropigmentation?” Although that is important because the average person wouldn’t want to be tattooed by a brand new artist, the length of time in practice may not accurately reflect that artist’s level of experience. For instance, an artist may say she has been practicing permanent cosmetics for 20 years, yet she may perform one procedure per month. Another artist may have been practicing half as long, 10 years, but may be busy performing 30-40 procedures per month.

In addition, most states do not require licensure for cosmetic/medical tattooing, so there are no regulations requiring continuing education courses to stay abreast of new developments in the field. Someone practicing for 20 years may or may not be up-to-date on advancements in equipment and techniques. That is another reason why is important for a patient to seek a truly certified professional with credentials from the American Academy of Micropigmentation or Society of Permanent Cosmetic Professionals.

Q. How do make sure I get the best, most natural result?

A. The best way to make that assessment is to look at her portfolio during a consultation. For medical tattooing, her portfolio should have Before, Immediately After (right after), and Healed After photographs. Make sure you see several examples of such work, especially healed photos to see how the pigment colors change. Our world is hectic and people are busy, so it can be challenging for an artist to obtain a healed photo of a patient following a touchup (second) procedure. However, at the very least, the artist should have healed photos that were taken during the patient’s touchup visit. Those healed photos actually become the new “before” photos prior to the second procedure so they are always taken

Q. Is there anything I should do to prepare for my tattoo?

A. From a physiological standpoint, there are several things a woman can do to increase her chances for a good outcome. First, she should do what she can to make her skin as smooth and healthy as possible to create a “good canvas” for the artist. For instance, if the skin on her reconstructed breast or nipple is dry and flakey, she should do some exfoliation treatments prior to her procedure. An easy method is to cleanse well with a facial scrub followed by the application of a good moisturizing cream. Or, if a woman had complications in her reconstruction that resulted in some elevated scars, she may want to have some preliminary micro-needling treatments to flatten the scars prior to tattooing.

Another step a woman can take to ensure that her skin is in good condition is to be well hydrated. Drinking at least 8 glasses of water each day is beneficial for healthy skin in general. When a woman is well hydrated, she will not retain water and swelling during the tattooing process will be less.

Other measures that should be taken are those that will minimize bleeding. Women should avoid any blood-thinning medications or supplements (anticoagulants) at least 3-5 days prior to the tattooing procedure.

Q. Even though I have gone through so much, I am still worried about the pain. What can be done to minimize it?

A. Fortunately, having a reconstructed breast tattooed is usually a significantly more comfortable experience than a conventional tattoo. First, the micropigmentation artist’s “canvas” is often numb to begin with due to nerve damage subsequent to surgery. Second, the reconstructed mound is fleshy so the tattooing will not be performed directly over a bone. Third, and most important, is that micropigmentation specialists use topical anesthetics to control pain. Properly trained and certified professionals use numbing agents before the procedure begins and then again during the procedure to minimize discomfort.

In addition, the pain control can be further enhanced if a woman has her nipple-areola tattooing performed by a medical professional. Physicians, nurse practitioners, physician assistants or other health care professionals who can prescribe medications with a DEA license can order and use stronger topical anesthetics from a compounding pharmacy. And when necessary, they can provide additional pain control measures through supplementation with oral medications or injections.