Fear- "An unpleasant feeling triggered by the perception of danger, real or imagined."
There can be apprehension involving this final step of breast reconstruction, especially for those ladies that have never been tattooed before. This can include fear to pick up the phone making an appointment to actually walking through the artist's door.
One of the many responsibilities a restorative tattoo artist has besides properly and safely creating a lovely piece of art on your skin is to help put you at ease. I've spent the last 25+ years of my life as a registered nurse comforting and supporting my patients and their families during some really difficult times. Honestly, the difference between a good and bad nurse really boils down to empathy. You either have it or you don't. It cannot be faked. The same goes for your tattoo artist 🎨. No matter who you pick, make sure they have this work in their heart ❤. You will be able to tell. Having confidence and trust in your artist can be the 1st step of overcoming any fears regarding tattooing you may have.
Those fears can include change because they may have been accustomed to seeing no color present for quite some time and change is scary. Will it look good when done? Will my partner like it? Will the tattoo help how I feel about my body? Will the artist be able to match my existing nipple (for unilateral reconstruction) or use my old photos for guidance? Can the tattoo help detract from my scars?
Also, they may have had an unsatisfactory tattoo done by their physician's office that faded away and honestly didn't look good to start with. 😭
That's terrible because they had high hopes of feeling normal again and ended up perhaps devastated by a bad tattoo outcome. How is this tattoo going to be different from the big let down I had before? Will it last? Will it look real?
I try to alleviate as much fear as I can by speaking personally with each client either by phone, zoom, or in person with a consultation. It allows an opportunity to ask any questions about tattooing and put some of those fears to rest. I also suggest if you're on the fence to try temporary nipple tattoos. I apply these during consultations. NIPPLEBACKS are awesome. They go on with a damp cloth and last for days. Get different styles, sizes and try them out! If you like a particular style, it can serve as inspiration for your permanent tattoo along with photos of mastectomy tattooing you've found online or your own preoperative pictures. A lot of details that go into your tattoo can best be communicated visually as this can be a hard thing to conceptualize and verbalize to your artist 🎨
XOXO,
The Nipple Fairy 🧚♀️
Thursday, December 9, 2021
Friday, June 4, 2021
Radiated Skin: Risks, Retention, and Realistic Expectations
🎀Today, I'd like to talk about radiated skin in breast reconstruction and special concerns regarding mastectomy tattooing. 🎀
🌸 I am not a physician, nor do I want anything I state here to replace information you get from your physician. Everything here is my own opinion from my own experiences. 🌸 I just want to discuss things that I feel can be quite beneficial to not only the client (as is the case with my previous blogs and videos) but also the 🎨 artist. Especially those that do not come from medical background, this information I feel is critically important to understand before you would ever take on the responsibility of tattooing a survivor.
🌸What is radiation used for in the world of medicine?
At low doses, radiation can be used for diagnostic purposes with x-rays and such. At higher doses, it is used therapeutically to shrink tumor masses and kill off cancer cells. This treatment many times is an adjunctive therapy used in addition to chemotherapy, immunotherapy and surgeries to both excise the cancer and reconstructive types of surgery. It can be delivered many ways...
🏵Orally in pill form, for the thyroid gland.
🏵Brachytherapy, which can an implantable form such as seeds which treat prostate, gynecological, and head and neck cancer or Intraoperative (IORT) XRT done directly to a visible tumor bed during surgery before closing. (As a nurse, I took care of a lot of gyn patients that had this done.) IORT can also be done at the time of lumpectomies....
As a restorative tattoo artist, you will many times be seeing the after effects of
🏵External Beam Radiation treatments (XRT) this consists of the beam of radiation originating outside the body and target projected onto the tumor area therapeutically in a series of multiple treatments. This is why you many times see those little blue/gray tattoo dots because they are markers to guide the placement on where to direct the beam.
🌸Note: I only neutralize the markers placed on the midline...I don't try to camouflage the others in case they'd need to be identified in the future for further treatments. Having said that, 2nd Note: there is a cumulative effect of radiation so there is a maximum amount one human can handle in their lifetime. For instance, you may hear a client tell you they had xrt with their 1st episode of breast cancer that was treated with a lumpectomy. Then at the time of their reoccurrence or new primary tumor, they didn't have xrt again or not many rounds the 2nd time because they reached their "max". They also may have previously had
🏵 Full Mantle radiation in the 60's and 70' s for Hodgkin's lymphoma. I personally have tattooed 3 ladies in the past 6 years in which this was the case....so it absolutely does happen.... mantle field xrt hit the neck, chest, and armpits to cover all the upper body lymph nodes they could. A big area. Subsequently, these ladies developed breast cancer in the 90's and had no additional xrt because they maxed out. So when they tell their past history that's the max dose they are referring to so it's good to make yourself familiar with these term if you're going to be treating someone who has experienced this.
🌸 So, what's the takeaway from this? 🌸
🎀 As a survivor, it is important to tell 🗣your artist about your radiation treatments and show👀 them the affected area.❓ Ask questions about their assessment of your skin being "tattooable" . Just because your doctor said it was ok, doesn't mean it actually it safe. I repeat: I've had a few women who were cleared to see me by their surgeon for tattooing and after I closely inspected their skin, I turned them away due to safety concerns with very damaged, thin skin. 💯 not safe to be tattooed in my professional opinion. Note*These docs were not from the Columbus metro area that I typically tattoo for...which is even more concerning because I don't know them and their note to me is not a guarantee that something won't go wrong. Better safe than sorry. Always.
❓Ask the artist how much experience they have with radiated skin. How many clients with a history of xrt have they personally tattooed. ❓How many complications have they had on clients with radiation. ❓ What are the risks? ❓What tattoo techniques do they apply to ensure your safety. ❓ Will or can the radiated skin heal differently? ❓ How many sessions will you anticipate?
As an artist,
💮 It is very important to ASK a potential client if they have ever received radiation treatments in the past.
💮If dealing with a flap, LD, tram or DIEP, it's important to know if xrt was pre or post flap. If pre, the damaged skin may have been removed completely so then it's not an issue but sometimes situations do require a fresh flap to be radiated. Many times the tattoo on an LD will fall part on and part off the flap. So different skin types and radiation can make things tricky.
💮 Be on the lookout for xrt dot marker tattoos which reveal the treated area. 👀
I've had that happen so many times where women even on their health history questionnaires they fill out at my office, will forget to fill in in that spot. Then when I get them disrobed, I see radiation markers which prompts me to ask. Then they say "Yes oh my gosh! I forget to put that on there. I wasn't even thinking about it."
It may have been a long time ago or it's just not fresh on their mind to reveal it without being asked. 💕This treatment can be emotionally traumatic so they may be protectively not thinking about it.
Especially if you are tattooing in a location outside of a medical environment. If somebody is super excited about getting a tattoo and they go to see you at a shop ...their mind is not in medical mode and they may forget to tell you.
🌸 Always ask and always look👀 because it's not like this treated skin will recover and get better over time returning to pre-radition condition. 🌸
I have heard physicians describe radiation therapy as "the gift that keeps on giving" . Giving in the sense of the skin has been forever changed and will sometimes keep changing on down the road.
It is documented that XRT has internal (heart, lung damage/scarring) and external side effects but, for our purposes today, I'll be focusing on just the external. The radiation must travel through the skin to treat cancer beneath so the skin essentially becomes collateral damage. We know xrt causes skin irritation and burns, sometimes extensive burns , thermal tissue type injuries during treatment. Once healed, there can be long term changes that can include hyperpigmentation/ darkened skin color, telangiectasia can be present, skin can be thinner, more fragile, tight, and shiny. The breast or breast reconstruction can sit higher , be firmer and smaller than the other non-radiated side. Capsular contracture of implants is very common as well.
The tattoo ink goes in the dermis as a liquid and the color particles get embedded into the cells by the needles. The body absorbs the liquid component and the cells of the dermis trap and"hold" the color particles in place.
However, because the cells have been forever changed by the radiation, many times they are unable to grasp and retain the ink effectively. So, crisp lines will blur and details will not stand out as you may wish. Additionally, the tattoo can heal lighter compared non-radiated tissue, such as compared to the other reconstructed breast or if the tattoo falls 1/2 on radiated skin and 1/2 on a healthy flap tissue portion of skin, like a DIEP or LD flap.
🗣This is an unpredictable canvas. 🗣You cannot anticipate the end result, so I love the 2 step approach. I am able to respect your skin and tattoo as safely as possible. Then when your return for touch up, it wll reveal how it acts. Sometimes, it heals the same!! Bonus! 🎉
More so in importance than the aesthetic outcome, is the risk of damaging radiated skin. This fragile skin must be tattooed extremely delicately, watching for cues on when it's had enough and stop ✋ when the time is right. I also always start on the radiated breast to see how the tissue will tolerate/accept the tattoo process and proceed cautiously. Remember the skin has been PERMANENTLY CHANGED, damaged really... by the XRT and so has it's ability to withstand trauma and HEAL. I get asked all the time if tattooing can pop an implant. This is not an issue with proper tattooing as our needles are contained in the dermis. However, creating a wound on a radiated breast mound can get infected, can become non healing or even erode and possibly expose an implant.
🗣This is a crucial element to understand when taking on the responsibility of tattooing a cancer survivor. You cannot be heavy handed attempting to pack in a ton of color on these ladies or it will end in heartbreak 💔. I've seen this 1st hand by uneducated staff tattooing this type of skin with an ignorant and cavalier approach and unfortunately the survivor pays the price with nonhealing wounds and compromised or lost breast reconstructions. Wound➡️ non- healing ➡️ erosion ➡️exposure of implant ➡️ possible loss of reconstruction.
I have personally tattooed hundreds of radiated breasts but I examine 🧐 each one's tissue integrity before I decide if it is safe to proceed, then I explain the risks to each person so they understand.
🌸In closing, can radiated breast reconstructions be tattooed? Most of the time, yes with special precautions by an experienced medical tattoo artist. Your physician and tattoo artist together can help safely determine if you're a candidate.
🌸 I am not a physician, nor do I want anything I state here to replace information you get from your physician. Everything here is my own opinion from my own experiences. 🌸 I just want to discuss things that I feel can be quite beneficial to not only the client (as is the case with my previous blogs and videos) but also the 🎨 artist. Especially those that do not come from medical background, this information I feel is critically important to understand before you would ever take on the responsibility of tattooing a survivor.
🌸What is radiation used for in the world of medicine?
At low doses, radiation can be used for diagnostic purposes with x-rays and such. At higher doses, it is used therapeutically to shrink tumor masses and kill off cancer cells. This treatment many times is an adjunctive therapy used in addition to chemotherapy, immunotherapy and surgeries to both excise the cancer and reconstructive types of surgery. It can be delivered many ways...
🏵Orally in pill form, for the thyroid gland.
🏵Brachytherapy, which can an implantable form such as seeds which treat prostate, gynecological, and head and neck cancer or Intraoperative (IORT) XRT done directly to a visible tumor bed during surgery before closing. (As a nurse, I took care of a lot of gyn patients that had this done.) IORT can also be done at the time of lumpectomies....
As a restorative tattoo artist, you will many times be seeing the after effects of
🏵External Beam Radiation treatments (XRT) this consists of the beam of radiation originating outside the body and target projected onto the tumor area therapeutically in a series of multiple treatments. This is why you many times see those little blue/gray tattoo dots because they are markers to guide the placement on where to direct the beam.
🌸Note: I only neutralize the markers placed on the midline...I don't try to camouflage the others in case they'd need to be identified in the future for further treatments. Having said that, 2nd Note: there is a cumulative effect of radiation so there is a maximum amount one human can handle in their lifetime. For instance, you may hear a client tell you they had xrt with their 1st episode of breast cancer that was treated with a lumpectomy. Then at the time of their reoccurrence or new primary tumor, they didn't have xrt again or not many rounds the 2nd time because they reached their "max". They also may have previously had
🏵 Full Mantle radiation in the 60's and 70' s for Hodgkin's lymphoma. I personally have tattooed 3 ladies in the past 6 years in which this was the case....so it absolutely does happen.... mantle field xrt hit the neck, chest, and armpits to cover all the upper body lymph nodes they could. A big area. Subsequently, these ladies developed breast cancer in the 90's and had no additional xrt because they maxed out. So when they tell their past history that's the max dose they are referring to so it's good to make yourself familiar with these term if you're going to be treating someone who has experienced this.
🌸 So, what's the takeaway from this? 🌸
🎀 As a survivor, it is important to tell 🗣your artist about your radiation treatments and show👀 them the affected area.❓ Ask questions about their assessment of your skin being "tattooable" . Just because your doctor said it was ok, doesn't mean it actually it safe. I repeat: I've had a few women who were cleared to see me by their surgeon for tattooing and after I closely inspected their skin, I turned them away due to safety concerns with very damaged, thin skin. 💯 not safe to be tattooed in my professional opinion. Note*These docs were not from the Columbus metro area that I typically tattoo for...which is even more concerning because I don't know them and their note to me is not a guarantee that something won't go wrong. Better safe than sorry. Always.
❓Ask the artist how much experience they have with radiated skin. How many clients with a history of xrt have they personally tattooed. ❓How many complications have they had on clients with radiation. ❓ What are the risks? ❓What tattoo techniques do they apply to ensure your safety. ❓ Will or can the radiated skin heal differently? ❓ How many sessions will you anticipate?
As an artist,
💮 It is very important to ASK a potential client if they have ever received radiation treatments in the past.
💮If dealing with a flap, LD, tram or DIEP, it's important to know if xrt was pre or post flap. If pre, the damaged skin may have been removed completely so then it's not an issue but sometimes situations do require a fresh flap to be radiated. Many times the tattoo on an LD will fall part on and part off the flap. So different skin types and radiation can make things tricky.
💮 Be on the lookout for xrt dot marker tattoos which reveal the treated area. 👀
I've had that happen so many times where women even on their health history questionnaires they fill out at my office, will forget to fill in in that spot. Then when I get them disrobed, I see radiation markers which prompts me to ask. Then they say "Yes oh my gosh! I forget to put that on there. I wasn't even thinking about it."
It may have been a long time ago or it's just not fresh on their mind to reveal it without being asked. 💕This treatment can be emotionally traumatic so they may be protectively not thinking about it.
Especially if you are tattooing in a location outside of a medical environment. If somebody is super excited about getting a tattoo and they go to see you at a shop ...their mind is not in medical mode and they may forget to tell you.
🌸 Always ask and always look👀 because it's not like this treated skin will recover and get better over time returning to pre-radition condition. 🌸
I have heard physicians describe radiation therapy as "the gift that keeps on giving" . Giving in the sense of the skin has been forever changed and will sometimes keep changing on down the road.
It is documented that XRT has internal (heart, lung damage/scarring) and external side effects but, for our purposes today, I'll be focusing on just the external. The radiation must travel through the skin to treat cancer beneath so the skin essentially becomes collateral damage. We know xrt causes skin irritation and burns, sometimes extensive burns , thermal tissue type injuries during treatment. Once healed, there can be long term changes that can include hyperpigmentation/ darkened skin color, telangiectasia can be present, skin can be thinner, more fragile, tight, and shiny. The breast or breast reconstruction can sit higher , be firmer and smaller than the other non-radiated side. Capsular contracture of implants is very common as well.
The tattoo ink goes in the dermis as a liquid and the color particles get embedded into the cells by the needles. The body absorbs the liquid component and the cells of the dermis trap and"hold" the color particles in place.
However, because the cells have been forever changed by the radiation, many times they are unable to grasp and retain the ink effectively. So, crisp lines will blur and details will not stand out as you may wish. Additionally, the tattoo can heal lighter compared non-radiated tissue, such as compared to the other reconstructed breast or if the tattoo falls 1/2 on radiated skin and 1/2 on a healthy flap tissue portion of skin, like a DIEP or LD flap.
🗣This is an unpredictable canvas. 🗣You cannot anticipate the end result, so I love the 2 step approach. I am able to respect your skin and tattoo as safely as possible. Then when your return for touch up, it wll reveal how it acts. Sometimes, it heals the same!! Bonus! 🎉
More so in importance than the aesthetic outcome, is the risk of damaging radiated skin. This fragile skin must be tattooed extremely delicately, watching for cues on when it's had enough and stop ✋ when the time is right. I also always start on the radiated breast to see how the tissue will tolerate/accept the tattoo process and proceed cautiously. Remember the skin has been PERMANENTLY CHANGED, damaged really... by the XRT and so has it's ability to withstand trauma and HEAL. I get asked all the time if tattooing can pop an implant. This is not an issue with proper tattooing as our needles are contained in the dermis. However, creating a wound on a radiated breast mound can get infected, can become non healing or even erode and possibly expose an implant.
🗣This is a crucial element to understand when taking on the responsibility of tattooing a cancer survivor. You cannot be heavy handed attempting to pack in a ton of color on these ladies or it will end in heartbreak 💔. I've seen this 1st hand by uneducated staff tattooing this type of skin with an ignorant and cavalier approach and unfortunately the survivor pays the price with nonhealing wounds and compromised or lost breast reconstructions. Wound➡️ non- healing ➡️ erosion ➡️exposure of implant ➡️ possible loss of reconstruction.
I have personally tattooed hundreds of radiated breasts but I examine 🧐 each one's tissue integrity before I decide if it is safe to proceed, then I explain the risks to each person so they understand.
🌸In closing, can radiated breast reconstructions be tattooed? Most of the time, yes with special precautions by an experienced medical tattoo artist. Your physician and tattoo artist together can help safely determine if you're a candidate.
Knowing the risks and understanding there must be realistic expectations regarding the outcome of a tattoo, like healing lighter and having blurred details on radiated skin, can help you decide if it's the choice for you or not. 🌸
#safetyfirst #themoreyouknow🌈 #experiencematters #alittleinkandalotoflove
#safetyfirst #themoreyouknow🌈 #experiencematters #alittleinkandalotoflove
Wednesday, May 12, 2021
Damage to the Skin and Deep Within
My name is Chrissy Siegel. I'm a nipple tattoo artist in Columbus Ohio. I've been a registered nurse for 25 yrs. I've worked in critical care (burns, Nicu, oncology) and a decade in plastic surgery (9 yrs in an academic setting and 1 year in private practice). I did medical tattooing for 8 plus years in an academic medical setting before training with professional body tattoo artists. I got into tattooing a little backwards compared to a permanent makeup artist or body artist that transitioned to paramedical tattooing. I was a nurse that was started tattooing with zero experience which is the case with most nurses assigned to tattooing in the office setting.
I'm making a video and writing this blog to help women decide which route they want to go making their own choice on how to complete their breast reconstruction. Additionally to clear up misconceptions that you've may have been told about tattooing that likely came from your physician or their staff/nurse. Also for those woman who have had a botched reconstructive nipple tattoo done by her surgeon and she's asking questions like "Why did it fade? Why does it look this way? Why do I have to have more touch ups and will the next touch up look better? Well.... they're not gonna tell you. Perhaps because they may not know the answers or maybe they don't to want change what they're doing. But I will tell you. 🗣
Today I'm going to discuss the differences between the type of tattooing done in medical offices and by some aestheticians/permanent make-up artists (who have unfortunately taken the wrong areola training) and what professional paramedical tattoo artists provide.
🇺🇸 Here in the US, decisions are made by each individual hospital or physician office regarding choosing staff who will preform the tattoo, equipment used, and inks. Most hospitals/ physician offices here have archaic thoughts still using permanent make up machines and semi permanent pigments because they were told they're safer, FDA approved, or they're "organic". Well, guess what else CAN be organic...carbon black tattoo ink. The repeated touch ups and ugly results, full of scar tissue, are for some reason accepted by the medical community as normal and it his needs to stop. ✋ Stop being accepted and just stop happening completely. I sometimes feel it's a trap,🪤 I suppose, set by the company "rep" who sell an expensive machine, expensive needles that said machine only takes, and then their pigments which are unstable/ low in lightfastness with awkward fading and turning of colors. (Terry Lively does a nice explanation on lightfastness and the blue wool scale on her youtube channel). So, after purchasing this expensive bundle of items, apparently they feel invested and keep accepting the awful results because it's a "medical tattoo". This is insanity.... these medical tattoos may have been the standard of care in 2005 or even 2010 but now, they are not. Patients know more now, they want more, and deserve more than this.
Medical tattooing is not regulated by insurance either in this country since it's a private payor system here. They'd probably prefer to have it done and over with once, to avoid repeat payouts but doctors on the other hand....bill each and every time for payment for multiple "touch ups". So, they're content to collect the money each visit you have. It's a money driven incentive indeed. Physician offices that continue to tattoo in house with terrible results do it for the money, not the results. I repeat... it's for money. 💲 Why do a beautiful breast reconstruction and ruin it with a terrible tattoo? Physicians that truly care about you will refer you to a professional tattooer. Bottom line.
I will continue to explain this further and back it up with my personal experience.
I did nurse tattooing for almost a decade. I wanted the ladies to have better results!!! So, I quit my job and trained with reputable tattoo artists both fundamentally and then for nipple specific training of course. Quitting nursing allowed me to devote all my time to only tattooing and really hone my craft to give results people deserve 💯.
There are 5 things I believe, no... I know to be wrong with medical tattooing. These tattoos I'm referring to are interchangeable...the same cosmetic tattoos done by nurses and some by aestheticians, that I now fix regularly.
1. Many physicians will inject lidocaine💉 intadermally (like a tb shot) which takes up the exact space I am trying to deposit ink into... this quite possibly is the worst thing to do. The ink is a liquid suspension and your body absorbs the liquid and the color particulate gets embedded into the dermis, trapped and held there. If the space is flooded, overflowing with lidocaine, this will not ideally happen. It's a huge interference and 10000% not necessary anyway. Topical creams are fine and adequate.
2. They will allow tattooing as early as 2 months after your last surgery. This is so insane, it really could have a whole discussion of it's own.
3. The ink. It is semi permanent, many times full of fillers, thick and creamy, and bottled as the same facial formulas that just happen to be made in nipple colors. The staff tattooing most likely does not know color theory/mixing for undertones. Plus, they only have maybe a handful of colors to use for the entire population of the universe. It doesn't matter anyway if they get the color right because this ink FADES y'all. MANY TIMES TO WEIRD SALMON, PEACH, OR GREY/PURPLE TONES..... THIS MEANS REPEATED TOUCH UPS.
In the USA, tattoo ink is considered a cosmetic product by the FDA, which means it's ingredients can be subject to regulation, but the ink itself isn't subject to approval. (The people that sell equipment to doctors tell them their semi permanent pigments are fda APPROVED but technically they're not like you think)
📝Per this article from fda.gov :
"The tattoo manufacturer and distributor are responsible for the safety of the products that they sell to retailers. The FDA monitors the safety of tattoos and permanent make-up and alerts the public when the agency becomes aware of any issues associated with inks."
(I am licensed with City of Columbus Health Department and Franklin County Health Department who have both emailed me when the FDA has a recall on ink.) Ultimately it's the responsibility of the artist to choose quality ink for their craft such as a company that meets high standards such as EU standards.
https://www.fda.gov/cosmetics/cosmetic-products/tattoos-temporary-tattoos-permanent-makeup
4. The equipment is wrong for body tattooing. Breasts are located on the body, not the face. So it's my belief that body art tattoo equipment is appropriate to be used.
✒ physicians typically use permanent makeup machines. Most nurses I know in multiple states use the Nouveau Contour system including inks and needles. It's a big racket. The machines are low powered meant for the thin skin on the face (dictated on speed to run rather than voltage from a power supply) so, because of this, the technician ends up making more passes, tearing up tissue and being much more heavy handed.
✒ The needle cartridges are also configured for small linear strokes/ small surface areas like brows and eyeliner, not the diameter of an areola and not scar tissue. Small needle groupings tightly configured so trying to cover surface area with that destroys the skin horribly compared to a nice big curved mag. Think stepping on a sharp pebble over and over again or walking on pea gravel without causing injury. Or painting a wall with a fat brush or a little artists brush. Efficiency =less trauma! The energy from our power sources are evenly distributed across the mag, not pinpointing and damaging. 📝 Note: a professional tattooer can whip shade with a smaller needle for texture or to layer color but that's not who I'm talking about here... these unskilled technicians are using small needles, going over and over in multiple passes, pressing too hard, damaging the skin.
5. Leading me to the next point of unskilled nontattooer staff providing this service. Not only unskilled but uneducated on the tattoo profession. As I stated previously, they most likely do not know color theory or possibly cannot even draw at all. If you cannot even draw a nipple on paper, why would you ever try on a human being??? Because it's in their job description. There is a lot that goes into these nipple tattoos like proper placement, size, symmetry, 3D effects, realism and details in addition to proper needle choice and techniques including working safely with scar tissue and radiated skin. They cannot execute proper techniques because they've not been taught. They also believe misinformation handed down to them and in turn passing it along to the patients. I've heard many times from ladies I do corrections on that they were told by the nurse "your skin just won't hold ink". This is even said to people with existing body art tattoos. Never mind that yellow rose on your ankle that's been there since 1993... the problem must be YOUR SKIN. 🚫 False. The problem is not your skin....it's all of this I am mentioning here. 😲 It's a multifaceted problem. 😲 Another untruth told over and over is that that "professional tattooers go too deep in the skin and it's unsafe for the implants and reconstruction in general". This is 100% False! 🚫 They are lying to you. Professional tattooers hit the sweet spot of the dermis because we know better and we've had adequate training. Unskilled folks are abraiding tissue repeatedly because they don't see take on the 1st (or multiple passes) thus, being too heavy handed blowing through the sweet spot creating an increase in bleeding, increase inflammation, and ink can't be captured and stay where there's no dermis left and ....SCAR .
❓So what kind of education/training do most nurses or aestheticians get to earn that little certificate you see on their wall? As an RN at a major university medical center, I personally watched 6 hours of videos from the Beau Institute, then watched another nurse tattoo a patient and I was turned loose... (see one, do one, teach one). Then 2 years into it, I had 2 day "training" by an pmu trainer and then later by another nurse from MD Anderson in Texas. They both did the same thing I was already doing per by the awful videos from before. These 2 day training sessions or online are typical in a medical setting for cosmetic tattooing. I've spoken to nurses in TX, NC, FL, IL, IN and KY and the all had similar, inadequate training. So, nurses and permanent makeup artists really need to research they training they take. Lots of training cost incredible amounts of money and the is terrible.
🗣Combine ALL OF THIS and its the perfect storm of DAMAGE done to fragile tissue REPEATEDLY for touch ups. Its UNETHICAL, DISFIGURING, AND DANGEROUS! It's not just dangerous physically but also to mental health‼️
❓So....who do we hold responsible?
I believe it's not the fault of the nurses, they are doing what they've been taught. I asked for better ink, better equipment, better training and kept getting told "No, what we do here is the standard of medical tattooing. It may not look perfect but, it's safe and it's good enough. This is your job description so if you don't like it, you can look elsewhere. We have nurses lined up out our door to have your job". No lie. This old surgeon with an archaic attitude and his academic administrative assistant (let me repeat that again so it sinks in) not a medical person, but a COO was in charge of making all the clinical decisions in our office and they both told me this was "good enough". I guarantee it wouldn't be good enough for their spouse, sister, mother, or daughter. They'd send them somewhere better...
The employee on the other hand, is doing their job. Nurses are wonderful people, empathetic people who care about humanity and want to help heal. Their heart is in the right place and want to do good...that's why they're nurses. I'm one too. I did exactly this. I didn't learn why it was wrong until I trained with a reputable, educated tattooer.
❓OK, SO WHY DOESN'T THE DOCTOR HAVE HIS STAFF PROPERLY TRAINED?
1. First of all, the physician/department must be able to disregard the old medical tattooing acceptance and see the NEED to offer better.
2. Secondly, as stated before, the staff on hand may not be interested in tattooing, not be artistic or not be able to draw.
3. The physician has to invest in the staff's training, new equipment, and scheduling to dedicate to tattooing. It is impossible to become expert level doing something a fraction of the time....nurse duties usually come 1st: office hours, phone calls, calling in meds, FMLA paperwork, TE fills, pulling drains, assisting in procedures, scrubbing instruments. The list is pretty long and then, oh yeah, do tattoos on Tuesday afternoon. To be good, you need dedicated staff to tattoo.
4. There's a risk, a BIG RISK, that once fully trained and comfortable, the staff will eventually leave to start her own independent business. 👋 yep, bye girl 👋 Think real hard about that part 🧐. Being a "boss girl" 💪and living the American dream is pretty glorious. Making her own flexible schedule with work life balance including time for kids. No more making her hourly wage and getting PTO time denied for vacations. She now is armed with everything she needs to be on her own to have her rewarding work, making her own money, instead of her already rich boss...richer. So she bolts and now the doctor is out a nurse and a tattoo artist.. 💣 The real the truth. 💣 compete clause be damned lol!
🎀 Again, if your tattoos were done in your reconstructive physician office 5-10-15 years ago, they probably didn't know any better option was available honestly. I started Living Story Tattoo in 2015 and there weren't a lot of artists at that time offering this service. Plus, the docs were like I said, in the trap, thinking what they were offering was indeed the standard of care. However, there is NO excuse NOW. Especially with social media and information available at your fingertips to patients and doctors alike. Physicians now, can no longer state these tattoos are good, acceptable, or the standard of care.
So, it comes down to either keep doing terrible restorative tattooing in house or refer your beloved patients out to an experienced, reputable, tattoo artist in the community. In Central Ohio where I live, most physicians do this. There are a few who still do office medical tattooing which comprises the majority of corrective tattooing that I do. I work 5 days a week and at least one of those days, I'm correcting/covering up a poorly done nipple tattoo.
I firmly believe the responsibility lies in the hands of the decision makers. The head of the departments in academic settings or the private practice owner/physician allowing this to take place in their office. That's who is willing to bill your insurance repeatedly for garbage tattoos and making payments on their luxury car at the expense of your mental health.
Damage is being done.
Damage to the Skin and Deep Within by awful tattooing. Our body image and self confidence are closely intertwined and a bad "finishing touch " can be devastating. The good news is, if you've had an unsatisfactory tattoo, a professional paramedical tattoo artist can most likely fix it. I personally fix them all the time. Nipple tattooing is supposed to be a beautiful grand finale to complete a breast reconstruction and it can be.
Areola Restorative Tattooing really does help close the chapter 🎀
I hope this helps explain the differences between what your physician may offer you versus what a properly trained tattoo artist can. Education is needed for the survivors!!!
XOXO,
The Nipple Fairy 🧚♀️
I'm making a video and writing this blog to help women decide which route they want to go making their own choice on how to complete their breast reconstruction. Additionally to clear up misconceptions that you've may have been told about tattooing that likely came from your physician or their staff/nurse. Also for those woman who have had a botched reconstructive nipple tattoo done by her surgeon and she's asking questions like "Why did it fade? Why does it look this way? Why do I have to have more touch ups and will the next touch up look better? Well.... they're not gonna tell you. Perhaps because they may not know the answers or maybe they don't to want change what they're doing. But I will tell you. 🗣
Today I'm going to discuss the differences between the type of tattooing done in medical offices and by some aestheticians/permanent make-up artists (who have unfortunately taken the wrong areola training) and what professional paramedical tattoo artists provide.
🇺🇸 Here in the US, decisions are made by each individual hospital or physician office regarding choosing staff who will preform the tattoo, equipment used, and inks. Most hospitals/ physician offices here have archaic thoughts still using permanent make up machines and semi permanent pigments because they were told they're safer, FDA approved, or they're "organic". Well, guess what else CAN be organic...carbon black tattoo ink. The repeated touch ups and ugly results, full of scar tissue, are for some reason accepted by the medical community as normal and it his needs to stop. ✋ Stop being accepted and just stop happening completely. I sometimes feel it's a trap,🪤 I suppose, set by the company "rep" who sell an expensive machine, expensive needles that said machine only takes, and then their pigments which are unstable/ low in lightfastness with awkward fading and turning of colors. (Terry Lively does a nice explanation on lightfastness and the blue wool scale on her youtube channel). So, after purchasing this expensive bundle of items, apparently they feel invested and keep accepting the awful results because it's a "medical tattoo". This is insanity.... these medical tattoos may have been the standard of care in 2005 or even 2010 but now, they are not. Patients know more now, they want more, and deserve more than this.
Medical tattooing is not regulated by insurance either in this country since it's a private payor system here. They'd probably prefer to have it done and over with once, to avoid repeat payouts but doctors on the other hand....bill each and every time for payment for multiple "touch ups". So, they're content to collect the money each visit you have. It's a money driven incentive indeed. Physician offices that continue to tattoo in house with terrible results do it for the money, not the results. I repeat... it's for money. 💲 Why do a beautiful breast reconstruction and ruin it with a terrible tattoo? Physicians that truly care about you will refer you to a professional tattooer. Bottom line.
I will continue to explain this further and back it up with my personal experience.
I did nurse tattooing for almost a decade. I wanted the ladies to have better results!!! So, I quit my job and trained with reputable tattoo artists both fundamentally and then for nipple specific training of course. Quitting nursing allowed me to devote all my time to only tattooing and really hone my craft to give results people deserve 💯.
There are 5 things I believe, no... I know to be wrong with medical tattooing. These tattoos I'm referring to are interchangeable...the same cosmetic tattoos done by nurses and some by aestheticians, that I now fix regularly.
1. Many physicians will inject lidocaine💉 intadermally (like a tb shot) which takes up the exact space I am trying to deposit ink into... this quite possibly is the worst thing to do. The ink is a liquid suspension and your body absorbs the liquid and the color particulate gets embedded into the dermis, trapped and held there. If the space is flooded, overflowing with lidocaine, this will not ideally happen. It's a huge interference and 10000% not necessary anyway. Topical creams are fine and adequate.
2. They will allow tattooing as early as 2 months after your last surgery. This is so insane, it really could have a whole discussion of it's own.
3. The ink. It is semi permanent, many times full of fillers, thick and creamy, and bottled as the same facial formulas that just happen to be made in nipple colors. The staff tattooing most likely does not know color theory/mixing for undertones. Plus, they only have maybe a handful of colors to use for the entire population of the universe. It doesn't matter anyway if they get the color right because this ink FADES y'all. MANY TIMES TO WEIRD SALMON, PEACH, OR GREY/PURPLE TONES..... THIS MEANS REPEATED TOUCH UPS.
In the USA, tattoo ink is considered a cosmetic product by the FDA, which means it's ingredients can be subject to regulation, but the ink itself isn't subject to approval. (The people that sell equipment to doctors tell them their semi permanent pigments are fda APPROVED but technically they're not like you think)
📝Per this article from fda.gov :
"The tattoo manufacturer and distributor are responsible for the safety of the products that they sell to retailers. The FDA monitors the safety of tattoos and permanent make-up and alerts the public when the agency becomes aware of any issues associated with inks."
(I am licensed with City of Columbus Health Department and Franklin County Health Department who have both emailed me when the FDA has a recall on ink.) Ultimately it's the responsibility of the artist to choose quality ink for their craft such as a company that meets high standards such as EU standards.
https://www.fda.gov/cosmetics/cosmetic-products/tattoos-temporary-tattoos-permanent-makeup
4. The equipment is wrong for body tattooing. Breasts are located on the body, not the face. So it's my belief that body art tattoo equipment is appropriate to be used.
✒ physicians typically use permanent makeup machines. Most nurses I know in multiple states use the Nouveau Contour system including inks and needles. It's a big racket. The machines are low powered meant for the thin skin on the face (dictated on speed to run rather than voltage from a power supply) so, because of this, the technician ends up making more passes, tearing up tissue and being much more heavy handed.
✒ The needle cartridges are also configured for small linear strokes/ small surface areas like brows and eyeliner, not the diameter of an areola and not scar tissue. Small needle groupings tightly configured so trying to cover surface area with that destroys the skin horribly compared to a nice big curved mag. Think stepping on a sharp pebble over and over again or walking on pea gravel without causing injury. Or painting a wall with a fat brush or a little artists brush. Efficiency =less trauma! The energy from our power sources are evenly distributed across the mag, not pinpointing and damaging. 📝 Note: a professional tattooer can whip shade with a smaller needle for texture or to layer color but that's not who I'm talking about here... these unskilled technicians are using small needles, going over and over in multiple passes, pressing too hard, damaging the skin.
5. Leading me to the next point of unskilled nontattooer staff providing this service. Not only unskilled but uneducated on the tattoo profession. As I stated previously, they most likely do not know color theory or possibly cannot even draw at all. If you cannot even draw a nipple on paper, why would you ever try on a human being??? Because it's in their job description. There is a lot that goes into these nipple tattoos like proper placement, size, symmetry, 3D effects, realism and details in addition to proper needle choice and techniques including working safely with scar tissue and radiated skin. They cannot execute proper techniques because they've not been taught. They also believe misinformation handed down to them and in turn passing it along to the patients. I've heard many times from ladies I do corrections on that they were told by the nurse "your skin just won't hold ink". This is even said to people with existing body art tattoos. Never mind that yellow rose on your ankle that's been there since 1993... the problem must be YOUR SKIN. 🚫 False. The problem is not your skin....it's all of this I am mentioning here. 😲 It's a multifaceted problem. 😲 Another untruth told over and over is that that "professional tattooers go too deep in the skin and it's unsafe for the implants and reconstruction in general". This is 100% False! 🚫 They are lying to you. Professional tattooers hit the sweet spot of the dermis because we know better and we've had adequate training. Unskilled folks are abraiding tissue repeatedly because they don't see take on the 1st (or multiple passes) thus, being too heavy handed blowing through the sweet spot creating an increase in bleeding, increase inflammation, and ink can't be captured and stay where there's no dermis left and ....SCAR .
❓So what kind of education/training do most nurses or aestheticians get to earn that little certificate you see on their wall? As an RN at a major university medical center, I personally watched 6 hours of videos from the Beau Institute, then watched another nurse tattoo a patient and I was turned loose... (see one, do one, teach one). Then 2 years into it, I had 2 day "training" by an pmu trainer and then later by another nurse from MD Anderson in Texas. They both did the same thing I was already doing per by the awful videos from before. These 2 day training sessions or online are typical in a medical setting for cosmetic tattooing. I've spoken to nurses in TX, NC, FL, IL, IN and KY and the all had similar, inadequate training. So, nurses and permanent makeup artists really need to research they training they take. Lots of training cost incredible amounts of money and the is terrible.
🗣Combine ALL OF THIS and its the perfect storm of DAMAGE done to fragile tissue REPEATEDLY for touch ups. Its UNETHICAL, DISFIGURING, AND DANGEROUS! It's not just dangerous physically but also to mental health‼️
❓So....who do we hold responsible?
I believe it's not the fault of the nurses, they are doing what they've been taught. I asked for better ink, better equipment, better training and kept getting told "No, what we do here is the standard of medical tattooing. It may not look perfect but, it's safe and it's good enough. This is your job description so if you don't like it, you can look elsewhere. We have nurses lined up out our door to have your job". No lie. This old surgeon with an archaic attitude and his academic administrative assistant (let me repeat that again so it sinks in) not a medical person, but a COO was in charge of making all the clinical decisions in our office and they both told me this was "good enough". I guarantee it wouldn't be good enough for their spouse, sister, mother, or daughter. They'd send them somewhere better...
The employee on the other hand, is doing their job. Nurses are wonderful people, empathetic people who care about humanity and want to help heal. Their heart is in the right place and want to do good...that's why they're nurses. I'm one too. I did exactly this. I didn't learn why it was wrong until I trained with a reputable, educated tattooer.
❓OK, SO WHY DOESN'T THE DOCTOR HAVE HIS STAFF PROPERLY TRAINED?
1. First of all, the physician/department must be able to disregard the old medical tattooing acceptance and see the NEED to offer better.
2. Secondly, as stated before, the staff on hand may not be interested in tattooing, not be artistic or not be able to draw.
3. The physician has to invest in the staff's training, new equipment, and scheduling to dedicate to tattooing. It is impossible to become expert level doing something a fraction of the time....nurse duties usually come 1st: office hours, phone calls, calling in meds, FMLA paperwork, TE fills, pulling drains, assisting in procedures, scrubbing instruments. The list is pretty long and then, oh yeah, do tattoos on Tuesday afternoon. To be good, you need dedicated staff to tattoo.
4. There's a risk, a BIG RISK, that once fully trained and comfortable, the staff will eventually leave to start her own independent business. 👋 yep, bye girl 👋 Think real hard about that part 🧐. Being a "boss girl" 💪and living the American dream is pretty glorious. Making her own flexible schedule with work life balance including time for kids. No more making her hourly wage and getting PTO time denied for vacations. She now is armed with everything she needs to be on her own to have her rewarding work, making her own money, instead of her already rich boss...richer. So she bolts and now the doctor is out a nurse and a tattoo artist.. 💣 The real the truth. 💣 compete clause be damned lol!
🎀 Again, if your tattoos were done in your reconstructive physician office 5-10-15 years ago, they probably didn't know any better option was available honestly. I started Living Story Tattoo in 2015 and there weren't a lot of artists at that time offering this service. Plus, the docs were like I said, in the trap, thinking what they were offering was indeed the standard of care. However, there is NO excuse NOW. Especially with social media and information available at your fingertips to patients and doctors alike. Physicians now, can no longer state these tattoos are good, acceptable, or the standard of care.
So, it comes down to either keep doing terrible restorative tattooing in house or refer your beloved patients out to an experienced, reputable, tattoo artist in the community. In Central Ohio where I live, most physicians do this. There are a few who still do office medical tattooing which comprises the majority of corrective tattooing that I do. I work 5 days a week and at least one of those days, I'm correcting/covering up a poorly done nipple tattoo.
I firmly believe the responsibility lies in the hands of the decision makers. The head of the departments in academic settings or the private practice owner/physician allowing this to take place in their office. That's who is willing to bill your insurance repeatedly for garbage tattoos and making payments on their luxury car at the expense of your mental health.
Damage is being done.
Damage to the Skin and Deep Within by awful tattooing. Our body image and self confidence are closely intertwined and a bad "finishing touch " can be devastating. The good news is, if you've had an unsatisfactory tattoo, a professional paramedical tattoo artist can most likely fix it. I personally fix them all the time. Nipple tattooing is supposed to be a beautiful grand finale to complete a breast reconstruction and it can be.
Areola Restorative Tattooing really does help close the chapter 🎀
I hope this helps explain the differences between what your physician may offer you versus what a properly trained tattoo artist can. Education is needed for the survivors!!!
XOXO,
The Nipple Fairy 🧚♀️
Thursday, April 22, 2021
To Nipple or Not to Nipple, that is the question.
To Nipple or Not.... Real Talk Q & A with a professional paramedical tattoo artist and registered nurse.
Disclaimer: Opinions expressed here are my own and no one else's and based on my experience as a registered nurse. I have just over a complete decade of plastic surgery nursing experience. I've observed, surgically assisted with and cared for post operatively, hundreds of nipple reconstructions made by multiple different physicians.
Note: I'm not a doctor or more specifically, I'm not your doctor. I always advise to refer questions you may have, regarding your care back to your own surgeon.
🌸A lot of people ask me during a consultation if I can guide them to make a decision whether to have a surgical nipple reconstruction or remain with flat skin and just get the 3D nipple tattoo. The question is "What is right for you?" It can be confusing.
Disclaimer: Opinions expressed here are my own and no one else's and based on my experience as a registered nurse. I have just over a complete decade of plastic surgery nursing experience. I've observed, surgically assisted with and cared for post operatively, hundreds of nipple reconstructions made by multiple different physicians.
Note: I'm not a doctor or more specifically, I'm not your doctor. I always advise to refer questions you may have, regarding your care back to your own surgeon.
🌸A lot of people ask me during a consultation if I can guide them to make a decision whether to have a surgical nipple reconstruction or remain with flat skin and just get the 3D nipple tattoo. The question is "What is right for you?" It can be confusing.
On one hand the physician practice you see may not offer this service or on the other hand, they may be pushing you to get nipple reconstruction as the "next step" of the process and you don't necessarily want another surgery but aren't sure what other options are out there.
🌸I always say that I have my own opinions on what I would personally do I ever faced with making that decision BUT, I cannot make the decision for anyone else.
I do ALWAYS answer any questions about nipple reconstruction honestly using my plastic surgery nursing experience and my experience as a professional tattooer specializing in nipple tattooing specifically.
🌸So, what is a nipple reconstruction surgery? Basically using some type of a skin flap is (elevated and folded or twisted upon itself) to fashion a protrusion on the breast mounds. Some physicians also do an areola skin graft around the nipple reconstruction. There is also a nipple "sharing" technique for unilateral reconstructions.
🌸How are they made? They are many different ways to create a surgical nipple reconstruction and it it's surgeon preference as to which technique is used. Some names you may have heard are: skate flap, C-V flap, double opposing tab method, beer can tab, bow tie flap, clover flap, twist techniques and more. All nipple reconstructions are definitely not created equal. It is very important to discuss this procedure with your surgeon and I'd highly recommend to ask to see photos of their personal work. Photos are helpful to see nipple reconstructions shown in all stages to see how the progression of healing appears on a reconstruction similar to your type. Make sure you see HEALED photos of what they look like at 6 months or longer out from surgery. They originally look quite large but many times, they flatten out eventually.
🌸PROS🌸:
🌺Appearance 🌺 It can help give an extremely natural appearance to help finish a woman's breast reconstruction, especially after combined with restorative tattooing. In a bilateral situation, the nipple reconstruction can help provide focal points the help detract from asymmetries. In a unilateral mastectomy situation this can bring a symmetrical look between the reconstructive and native breast sides, especially if her natural nipple protrudes.
🌺Pain 🌺 due to taking place after the mastectomy, pain is typically tolerated well in this area.
🌺Procedure 🌺 usually in office or out patient procedure. Can be coupled with other procedures in phase II or lll
🌺After care 🌺 not as difficult as previous bigger surgical procedures. Mostly consists of keeping area clean and applying a protective/pressure relieving dressing on top until healed.
🌸CONS🌸:
🌺Appearance 🌺
💮 They CAN flatten 💮
They can flatten as stated above, they originally look quite large in the beginning but many times, they flatten out eventually. This is frustrating for unilateral reconstruction ladies as they'd hoped for an equal nipple to be made for them.
Many things contribute to this happening:
1. Physician surgical technique
2. Was proper aftercare followed and pressure reduced from new nipple? No smoking 🚭 this can severely damage or cause tissue death to the nipple.
3. What type of breast reconstruction makes up your breast? DIEP flaps/TRAM flaps and LD flaps have more tissue beneath to recruit and fill the nipple reconstruction. Implant skin is thinner and flattens out quite often in my experience. Many physicians where I live do not offer nipple reconstruction (especially if your skin is thin) on implant based breast reconstruction and just refer them for 3D nipple tattoos for this reason.
💮They MAY NOT flatten💮
Sometimes women are told not to be afraid of the large size initially and don't worry as they'll flatten and shrink. Well, sometimes....they don't. This then requires traveling back to the days of padded bras and bandaids for some ladies.
💮 One flattened and one doesn't 💮
They do not always flatten at same rate or end up the same size. So frustrating...
💮 They're not placed in the right spot 💮
This happens a lot....it may have to do with blood supply and scar placement. However, my job (placing color around the nipple) can accentuate this asymmetry even more, once tattoo ink is in the skin. If the nipple reconstruction is flattened, I can create a 3D nipple in the proper place but, if it's really prominent and really off placed it may require surgical treatment to fix. I can usually tattoo in a way to make things as symmetrical as possible.
🌸I always say that I have my own opinions on what I would personally do I ever faced with making that decision BUT, I cannot make the decision for anyone else.
I do ALWAYS answer any questions about nipple reconstruction honestly using my plastic surgery nursing experience and my experience as a professional tattooer specializing in nipple tattooing specifically.
🌸So, what is a nipple reconstruction surgery? Basically using some type of a skin flap is (elevated and folded or twisted upon itself) to fashion a protrusion on the breast mounds. Some physicians also do an areola skin graft around the nipple reconstruction. There is also a nipple "sharing" technique for unilateral reconstructions.
🌸How are they made? They are many different ways to create a surgical nipple reconstruction and it it's surgeon preference as to which technique is used. Some names you may have heard are: skate flap, C-V flap, double opposing tab method, beer can tab, bow tie flap, clover flap, twist techniques and more. All nipple reconstructions are definitely not created equal. It is very important to discuss this procedure with your surgeon and I'd highly recommend to ask to see photos of their personal work. Photos are helpful to see nipple reconstructions shown in all stages to see how the progression of healing appears on a reconstruction similar to your type. Make sure you see HEALED photos of what they look like at 6 months or longer out from surgery. They originally look quite large but many times, they flatten out eventually.
🌸PROS🌸:
🌺Appearance 🌺 It can help give an extremely natural appearance to help finish a woman's breast reconstruction, especially after combined with restorative tattooing. In a bilateral situation, the nipple reconstruction can help provide focal points the help detract from asymmetries. In a unilateral mastectomy situation this can bring a symmetrical look between the reconstructive and native breast sides, especially if her natural nipple protrudes.
🌺Pain 🌺 due to taking place after the mastectomy, pain is typically tolerated well in this area.
🌺Procedure 🌺 usually in office or out patient procedure. Can be coupled with other procedures in phase II or lll
🌺After care 🌺 not as difficult as previous bigger surgical procedures. Mostly consists of keeping area clean and applying a protective/pressure relieving dressing on top until healed.
🌸CONS🌸:
🌺Appearance 🌺
💮 They CAN flatten 💮
They can flatten as stated above, they originally look quite large in the beginning but many times, they flatten out eventually. This is frustrating for unilateral reconstruction ladies as they'd hoped for an equal nipple to be made for them.
Many things contribute to this happening:
1. Physician surgical technique
2. Was proper aftercare followed and pressure reduced from new nipple? No smoking 🚭 this can severely damage or cause tissue death to the nipple.
3. What type of breast reconstruction makes up your breast? DIEP flaps/TRAM flaps and LD flaps have more tissue beneath to recruit and fill the nipple reconstruction. Implant skin is thinner and flattens out quite often in my experience. Many physicians where I live do not offer nipple reconstruction (especially if your skin is thin) on implant based breast reconstruction and just refer them for 3D nipple tattoos for this reason.
💮They MAY NOT flatten💮
Sometimes women are told not to be afraid of the large size initially and don't worry as they'll flatten and shrink. Well, sometimes....they don't. This then requires traveling back to the days of padded bras and bandaids for some ladies.
💮 One flattened and one doesn't 💮
They do not always flatten at same rate or end up the same size. So frustrating...
💮 They're not placed in the right spot 💮
This happens a lot....it may have to do with blood supply and scar placement. However, my job (placing color around the nipple) can accentuate this asymmetry even more, once tattoo ink is in the skin. If the nipple reconstruction is flattened, I can create a 3D nipple in the proper place but, if it's really prominent and really off placed it may require surgical treatment to fix. I can usually tattoo in a way to make things as symmetrical as possible.
💮Nipple death /necrosis 💮
This is typically a blood supply issue, either from the base of the reconstruction, pressure/folding over and kinking supply or due to smoking.
🌺Aftercare/risks 🌺
💮procedure 💮
1. It's an additional procedure that may incur an expense with co-pays and deductible costs.
2. It CAN put an additional scar on the breast, which may or may not be covered with an areola tattoo.
3. No surgery is without risk. Undergoing possible anesthesia, infection and tissue death/loss are a few of them.
4. Radiation causes additional risks. Many times surgical nipple reconstruction is not an option in a radiated skin field.
5. The protrusions and surrounding skin in the areola field are not colored adequately for a completed appearance. Areola restorative tattooing to usually desired for the "grand finale or finishing touch".
💮aftercare💮
Even though it's relatively easy, there's still aftercare required and avoidance of water activities until healed.
🌸Your physician will determine if you are a candidate for this procedure. If you've had radiation or have thin skin, you may not be eligible.
🌸 In conclusion, your finishing touch can be a 3D Nipple Tattoo on completely flat skin or over a surgically created nipple reconstruction. The beauty is, you can CHOOSE! Either way, you can achieve a finished appearance to your breast reconstruction. I love your participation in placement, color selection and details you choose to have added. There is a very tolerable recovery for the tattoo sessions which usually requires keeping the area clean, moisturized and protected. I tattoo in 2 visits done about 10 weeks apart.
🌺Aftercare/risks 🌺
💮procedure 💮
1. It's an additional procedure that may incur an expense with co-pays and deductible costs.
2. It CAN put an additional scar on the breast, which may or may not be covered with an areola tattoo.
3. No surgery is without risk. Undergoing possible anesthesia, infection and tissue death/loss are a few of them.
4. Radiation causes additional risks. Many times surgical nipple reconstruction is not an option in a radiated skin field.
5. The protrusions and surrounding skin in the areola field are not colored adequately for a completed appearance. Areola restorative tattooing to usually desired for the "grand finale or finishing touch".
💮aftercare💮
Even though it's relatively easy, there's still aftercare required and avoidance of water activities until healed.
🌸Your physician will determine if you are a candidate for this procedure. If you've had radiation or have thin skin, you may not be eligible.
🌸 In conclusion, your finishing touch can be a 3D Nipple Tattoo on completely flat skin or over a surgically created nipple reconstruction. The beauty is, you can CHOOSE! Either way, you can achieve a finished appearance to your breast reconstruction. I love your participation in placement, color selection and details you choose to have added. There is a very tolerable recovery for the tattoo sessions which usually requires keeping the area clean, moisturized and protected. I tattoo in 2 visits done about 10 weeks apart.
If you're undecided, I suggest looking at physician photos, talking with those who had nipple reconstruction or the 3D tattoo regarding their experiences, and also trying NIPPLEBACKS. They're temporary nipple tattoos that can really help you decide what's right for you!
https://www.nipplebacks.com/shop-1
XOXO,
The Nipple Fairy 🧚♀️
https://www.nipplebacks.com/shop-1
XOXO,
The Nipple Fairy 🧚♀️
Friday, April 9, 2021
Nipple Tattooing Explained & Tips on How to Choose Your Artist.
I specialize in restorative tattooing of the breast. Restorative, in the sense of giving back a version of what was once taken away. Specifically, the majority of my work is
tattooing of the nipple areola complex as the finishing touch to a breast reconstruction. It needs to be the very last step of your breast reconstruction, ideally with no additional surgeries planned in the immediate future. It is a medical tattoo with an aesthetic touch. I call it the grande finale!
Medical tattooing for the breast can be used in the following:
🌸 In breast reconstruction patients after a mastectomy, to recreate a natural and realistic appearing nipple areola complex. This can be done over a nipple reconstruction or without, on flat skin, using a 3D tattooing technique. Areola restoration can be used on nipple-sparing masectomies where the native areola has been attempted to be preserved.
🌸 After other breast procedures, such as breast reduction, mastopexy surgeries or top surgeries, where the pigment has been lost or to achieve areola symmetry.
🌸 Tattooing can restore absent areola pigmentation for treatment of vitiligo on the nipple-areola complex.
🌸 Tattooing can also be chosen as a cosmetic elective procedure purely per client preferences due to desiring a darker areola. Another aesthetic option is to change the areola into a fun shape like a heart.
Specific to breast reconstruction, after your surgeon has rebuilt your breast, the tattoo is done to restore a feminine appearance to the breast. As stated before, it should be the final step...the grand finale of the reconstruction process.
If you chose to have a nipple reconstruction procedure, the color is applied to the nipple and surrounding skin to create natural looking areola.
If you chose to avoid additional surgery or have found your previously created nipple has flattened out and is no longer dimensional, then a 3D tattoo is a great option. This type of tattoo is essentially a portrait tattoo of a nipple. It requires a 3 dimensional illusion to be created on a 2 dimensional surface. With specialized training, the artist can create a realistic, natural looking nipple and areola using light and shadow techniques.
No matter what the case, I use high quality tattoo ink and body art tattoo equipment to ensure a beautiful result that lasts.
You may remember hearing during your breast reconstruction consultation that
the goal of your plastic surgeon is to make you appear "normal " in clothes and your bathing suit. As a plastic surgery nurse, I've heard this said hundreds of times by physicians. The goal of nipple tattooing however, is to help you feel good looking at yourself OUT of clothing. So, that glimpse in the mirror after a shower isn't a constant reminder of what you've been through. Also, the nipple tattoos help soften and detract from asymmetries that may be present between the two breasts and many times help pull the eye away from scars you feel are unsightly.
This is a big responsibility for the artist 🎨 and that's why choosing the right one is so important!
So, how do you choose your artist? Where do you start?
1. First off, look at their photos 📷! Especially HEALED PHOTOS. It is impossible to tell much at all by looking at a fresh and red tattoo. I love showing my gallery of pictures to clients, which includes both fresh and healed examples. Every artist has a different style. Healed photos will tell you so much!
2. Ask about their equipment, ink, and training and experience level. Was your training a 2 day class or online? Are they certified in Areola Restorative Tattooing? How many tattoos have you done? Do you use permanent makeup pigment or tattoo ink? How many touch ups will I need?
3. Talk to past clients. Read reviews on their experiences.
4. Who does your physician recommend?
Take the time to find a good fit with your artist. You deserve to have all your questions answered in terms you understand. Get educated and make your choice.. this maybe the one time that 100% of the choice is yours during the reconstruction process. You don't have to settle for cookie cutter, assembly line nipple tattoos which are barely a step up from the bullseye, pepperoni nipple tattoos done in physician offices...slightly better than a pepperoni does not mean great.
💞 Perhaps most important of all, make sure whomever you choose to do your work, that it's in their heart ❤ You will be able to tell. I am very passionate and protective of my work, as should be any artist who does restorative tattooing. It is truly a privilege for me and I'm grateful to do it everyday.
XOXO,
The Nipple Fairy 🧚♀️
tattooing of the nipple areola complex as the finishing touch to a breast reconstruction. It needs to be the very last step of your breast reconstruction, ideally with no additional surgeries planned in the immediate future. It is a medical tattoo with an aesthetic touch. I call it the grande finale!
Medical tattooing for the breast can be used in the following:
🌸 In breast reconstruction patients after a mastectomy, to recreate a natural and realistic appearing nipple areola complex. This can be done over a nipple reconstruction or without, on flat skin, using a 3D tattooing technique. Areola restoration can be used on nipple-sparing masectomies where the native areola has been attempted to be preserved.
🌸 After other breast procedures, such as breast reduction, mastopexy surgeries or top surgeries, where the pigment has been lost or to achieve areola symmetry.
🌸 Tattooing can restore absent areola pigmentation for treatment of vitiligo on the nipple-areola complex.
🌸 Tattooing can also be chosen as a cosmetic elective procedure purely per client preferences due to desiring a darker areola. Another aesthetic option is to change the areola into a fun shape like a heart.
Specific to breast reconstruction, after your surgeon has rebuilt your breast, the tattoo is done to restore a feminine appearance to the breast. As stated before, it should be the final step...the grand finale of the reconstruction process.
If you chose to have a nipple reconstruction procedure, the color is applied to the nipple and surrounding skin to create natural looking areola.
If you chose to avoid additional surgery or have found your previously created nipple has flattened out and is no longer dimensional, then a 3D tattoo is a great option. This type of tattoo is essentially a portrait tattoo of a nipple. It requires a 3 dimensional illusion to be created on a 2 dimensional surface. With specialized training, the artist can create a realistic, natural looking nipple and areola using light and shadow techniques.
No matter what the case, I use high quality tattoo ink and body art tattoo equipment to ensure a beautiful result that lasts.
You may remember hearing during your breast reconstruction consultation that
the goal of your plastic surgeon is to make you appear "normal " in clothes and your bathing suit. As a plastic surgery nurse, I've heard this said hundreds of times by physicians. The goal of nipple tattooing however, is to help you feel good looking at yourself OUT of clothing. So, that glimpse in the mirror after a shower isn't a constant reminder of what you've been through. Also, the nipple tattoos help soften and detract from asymmetries that may be present between the two breasts and many times help pull the eye away from scars you feel are unsightly.
This is a big responsibility for the artist 🎨 and that's why choosing the right one is so important!
So, how do you choose your artist? Where do you start?
1. First off, look at their photos 📷! Especially HEALED PHOTOS. It is impossible to tell much at all by looking at a fresh and red tattoo. I love showing my gallery of pictures to clients, which includes both fresh and healed examples. Every artist has a different style. Healed photos will tell you so much!
2. Ask about their equipment, ink, and training and experience level. Was your training a 2 day class or online? Are they certified in Areola Restorative Tattooing? How many tattoos have you done? Do you use permanent makeup pigment or tattoo ink? How many touch ups will I need?
3. Talk to past clients. Read reviews on their experiences.
4. Who does your physician recommend?
Take the time to find a good fit with your artist. You deserve to have all your questions answered in terms you understand. Get educated and make your choice.. this maybe the one time that 100% of the choice is yours during the reconstruction process. You don't have to settle for cookie cutter, assembly line nipple tattoos which are barely a step up from the bullseye, pepperoni nipple tattoos done in physician offices...slightly better than a pepperoni does not mean great.
💞 Perhaps most important of all, make sure whomever you choose to do your work, that it's in their heart ❤ You will be able to tell. I am very passionate and protective of my work, as should be any artist who does restorative tattooing. It is truly a privilege for me and I'm grateful to do it everyday.
XOXO,
The Nipple Fairy 🧚♀️
Friday, March 5, 2021
Who or What Exactly is The Nipple Fairy 🧚♀️?
Who or what exactly is The Nipple Fairy 🧚♀️?
I am a registered nurse and experienced medical tattoo artist.
I specialize in restorative tattooing of the breast. Restorative, in the sense of giving back a version of what was once taken away. Specifically, the majority of my work is
tattooing of the nipple areola complex as the finishing touch to a breast reconstruction. It is a medical tattoo with an aesthetic touch. I call it the grande finale!
I originally wanted to attend art school but after the death of my mother at age 15, I decided to change paths to nursing, to help people. After graduating from Wright State University in 1996 with a Bachelor’s of Science in Nursing degree, I worked in a variety of hospital areas including: Burn unit, Neuro/Trauma, NICU, and Oncology.
I worked at The Ohio State University Medical Center’s Department of Plastic Surgery from 2006-2014 where I completed hands-on training by a nurse and The Beau Institute, Advanced Areola Complex training series. I was responsible for tattooing a large volume of patients in need of nipple areola complex tattooing and loved every minute of it. I was not, however loving the results I was providing. So, in 2014, I decided to seek proper training with licensed tattoo artists and there I learned everything I had been taught to do by the other nurses and aestheticians previously was completely wrong. I was devastated that for so many years, I'd contributed to a huge problem, globally really, of poor nipple tattooing.
In 2015, I made the jump to start Living Story Tattoo L.L.C. I walked away from a steady paycheck, retirement and benefits to pursue my dream of providing quality tattoos that survivors deserve 💕 In 2017, I took A.R.T. training to help ensure I was providing the best results possible.
So, how did I get named "The Nipple Fairy" 🧚♀️? My brother came to visit our grandma that lived with me and he viewed my Instagram account for the 1st time. He then said to me "This is what you do? You gift nipples back to women! You're like the nipple fairy "!!! And there it was....
Locally, this has caught on and I'm known in these parts as "The Nipple Fairy " now. ❤
So, I don't do a traditional nursing job but I still feel like a nurse at heart. This is the best of both worlds for me. Art plus my nursing background equals my dream job...I love it ! I tattoo full time M-F and devote myself to helping women look and feel beautiful and whole again.
I am a registered nurse and experienced medical tattoo artist.
I specialize in restorative tattooing of the breast. Restorative, in the sense of giving back a version of what was once taken away. Specifically, the majority of my work is
tattooing of the nipple areola complex as the finishing touch to a breast reconstruction. It is a medical tattoo with an aesthetic touch. I call it the grande finale!
I originally wanted to attend art school but after the death of my mother at age 15, I decided to change paths to nursing, to help people. After graduating from Wright State University in 1996 with a Bachelor’s of Science in Nursing degree, I worked in a variety of hospital areas including: Burn unit, Neuro/Trauma, NICU, and Oncology.
I worked at The Ohio State University Medical Center’s Department of Plastic Surgery from 2006-2014 where I completed hands-on training by a nurse and The Beau Institute, Advanced Areola Complex training series. I was responsible for tattooing a large volume of patients in need of nipple areola complex tattooing and loved every minute of it. I was not, however loving the results I was providing. So, in 2014, I decided to seek proper training with licensed tattoo artists and there I learned everything I had been taught to do by the other nurses and aestheticians previously was completely wrong. I was devastated that for so many years, I'd contributed to a huge problem, globally really, of poor nipple tattooing.
In 2015, I made the jump to start Living Story Tattoo L.L.C. I walked away from a steady paycheck, retirement and benefits to pursue my dream of providing quality tattoos that survivors deserve 💕 In 2017, I took A.R.T. training to help ensure I was providing the best results possible.
So, how did I get named "The Nipple Fairy" 🧚♀️? My brother came to visit our grandma that lived with me and he viewed my Instagram account for the 1st time. He then said to me "This is what you do? You gift nipples back to women! You're like the nipple fairy "!!! And there it was....
Locally, this has caught on and I'm known in these parts as "The Nipple Fairy " now. ❤
So, I don't do a traditional nursing job but I still feel like a nurse at heart. This is the best of both worlds for me. Art plus my nursing background equals my dream job...I love it ! I tattoo full time M-F and devote myself to helping women look and feel beautiful and whole again.
To help further educate women and spread the word about mastectomy tattooing, I've started to blog again and will be hosting an informative podcast! I will be discussing all things mastectomy tattoos! I hope you enjoy it.
Keep well,
Chrissy
The Nipple Fairy 🧚♀️
Keep well,
Chrissy
The Nipple Fairy 🧚♀️
Thursday, May 28, 2020
COVID-19 SAFETY PROTOCOLS
I am excited to be coming back y'all! 🤗 There are a lot of things I want to make you fully aware of when coming to see me. Please read the content in it's entirety and if anyone has any questions, feel free to ask. I will be following the guidelines set by our Governor and the health departments. I am a licensed tattoo artist with both City of Columbus and Franklin County Health Departments. Additionaly, please be assured that with my 24 years of registered nursing experience and strict tattooing aseptic standards, I will be doing my absolute best to ensure our safety with the following requirements listed. 😉
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PROTOCOLS FOR ME AND STAFF AT EACH LOCATION
Temperature checks and self health assessment:
-We (me and the staff at the offices) will take our temperatures prior to guest arrival, and we will not come in if feeling ill, or if our temperature is above 🤒99.5, or have had exposure to sick individuals.
Hygiene and disinfecting:
-I will wash 🧼 and disinfect my hands regularly, especially before and after each guest.
-I will clean and disinfect frequently touched surfaces before and after each guest. This will include: chairs in my office, door handles, counter tops, shared surfaces and more. My equipment will be disinfected and draped to cover as it always has for blood borne pathogen prevention.
-We will clean and disinfect common areas frequently throughout the day such as door handles, bathroom, etc in the entire office area.
-There will not be magazines, snacks or beverages available at this time. The common waiting areas will not be used.
-I will only serve one guest at a time, by appointment only, (max of 2 clients per day) in order to maintain proper social distancing and to allow time in between each guest for thorough cleaning and disinfecting.
-My office doors will remain open during the appointment. This is ensure adequate ventilation/air circulation. At the Bing, I have a curtain to pull for privacy at the door. In Gahanna, I have a dressing screen to be placed in front of my door. No one will be seen in undress and your privacy will be maintained.
Masks and PPE:
-I will be wearing a mask😷 for your safety as well as mine throughout your entire appointment time. I will additionally wear disposable arm coverings and a full face shield while tattooing. Other office staff will also be wearing masks and following social distancing procedures per each location's own requirements.
*******************
PROTOCOLS FOR CLIENTS
*Prior to your appointment*
Self health assessment:
I ask you take your temperature at home the night before/morning of to help ensure you are well. If you have ANY symptoms of illness (even if you think it's just allergies) or been exposed to anyone who has been ill within 72 hrs, rescheduling is required. Obviously, if you have had a known/confirmed or suspected exposure to COVID-19 within the last 30 days, please let me know so you can be rescheduled following your self quarantine period and of course, are symptom free. If you have had COVID-19 and recovered, negative testing will need to be obtained prior to attending your appointment to ensure safety.
Travel:
Also if you have traveled ✈ outside the country within the last 30 days of your appointment, we will need to get you rescheduled outside that window.
-Please schedule for 14 days after being in a large crowd of have traveled out of state.
*Day of your appointment *
Companions:
-Please refrain from bringing anyone extra with you. If someone has driven you to your appointment, they must wait in the car or have other plans to pass the time as no companions will be allowed inside at either location. The only exception to this is an interpreter required to communicate.
Arrival:
- There is no need to arrive early. Please text me from your car when you arrive for your appointment. I will let you know when you can enter the building . I do not have great phone reception in the Specialty Care Clinic at the Bing center. If I do not respond back right away, please try me again by☎️ calling my phone.
-Please limit bringing in personal items. Try to keep it to keys, phone, a water/beverage bottle and payment type. Personal items brought in will be wiped with sanitizing cloths upon arrival. I have hospital type linen/gown services available at both locations.
Temperature checks:
-Upon entering the building at the elevator of the Bing or the front of the office in Gahanna, your temperature will be taken. If above 99.5, you will not be allowed to enter further and will need to reschedule.
Masks:
If you’re looking for more ways to protect yourself and your loved ones, check out the CDC website.
Thank you so much for sticking with me. 🥰 I look forward to supporting each other during these challenging times.
Chrissy ❤
#covid19 #safetyfirst
*Day of your appointment *
Companions:
-Please refrain from bringing anyone extra with you. If someone has driven you to your appointment, they must wait in the car or have other plans to pass the time as no companions will be allowed inside at either location. The only exception to this is an interpreter required to communicate.
Arrival:
- There is no need to arrive early. Please text me from your car when you arrive for your appointment. I will let you know when you can enter the building . I do not have great phone reception in the Specialty Care Clinic at the Bing center. If I do not respond back right away, please try me again by☎️ calling my phone.
-Please limit bringing in personal items. Try to keep it to keys, phone, a water/beverage bottle and payment type. Personal items brought in will be wiped with sanitizing cloths upon arrival. I have hospital type linen/gown services available at both locations.
Temperature checks:
-Upon entering the building at the elevator of the Bing or the front of the office in Gahanna, your temperature will be taken. If above 99.5, you will not be allowed to enter further and will need to reschedule.
Masks:
-I know not everyone will be excited about this part, but as you are well aware, I tattoo inside medical offices where cancer patients 🎀 are seen, many with lowered immune systems. We must be responsible to keep them safe as well.
-I will further share with you, my son 💗 at home has an autoimmune disorder and takes medication that compromises his immune system. I must take ALL steps seriously to not bring anything home to him. I appreciate your understanding on this matter and why it means so much to me personally.
- It is for these reasons above combined with rules from the health departments and institutions I rent from, that I'm requiring clients to wear masks for our combined safety. I have the right to and WILL deny services if not wearing a mask. 😷 This is for all of our safety and must be worn during our ENTIRE time together over your mouth AND nose properly. NO exceptions.
-At the Bing, a mask will be provided to you at the temperature desk, if you do not wear your own from home.
-At my office in Gahanna, you will be required to bring your own face covering. It can be a homemade cloth covering or mask appropriately applied. In case you forget one, I will do my best to supply one for you but my supplies are EXTREMELY LIMITED.
-I will further share with you, my son 💗 at home has an autoimmune disorder and takes medication that compromises his immune system. I must take ALL steps seriously to not bring anything home to him. I appreciate your understanding on this matter and why it means so much to me personally.
- It is for these reasons above combined with rules from the health departments and institutions I rent from, that I'm requiring clients to wear masks for our combined safety. I have the right to and WILL deny services if not wearing a mask. 😷 This is for all of our safety and must be worn during our ENTIRE time together over your mouth AND nose properly. NO exceptions.
-At the Bing, a mask will be provided to you at the temperature desk, if you do not wear your own from home.
-At my office in Gahanna, you will be required to bring your own face covering. It can be a homemade cloth covering or mask appropriately applied. In case you forget one, I will do my best to supply one for you but my supplies are EXTREMELY LIMITED.
Consent and contact tracing:
-There will be new COVID-19 paperwork added to your chart 📋
-Stepping into my office tells me, you knowingly and willingly consent to have tattoo services done during the COVID-19 pandemic. Please contact me if you at any time show symptoms of COVID-19. Please make sure I have a proper phone number for you as well, in case I would need to let you know the same.
Hygiene:
- After coming back to my room, personal items (phone, bottle) will be wiped down and you will be provided with hand sanitizer to cleanse your hands before we get started. This will be applied again after the consultation portion of your visit, right before laying on my chair which has been thoroughly disinfected and draped prior to your arrival.
-Please for continued hygiene purposes refrain from touching your mask and facial area in general. If a break is required for bathroom or a sip of water, we will readjust 😷and clean hands 🧼again before starting back up. Per usual procedure, avoid 🚫touching your tattoo area with your hands during the appointment.
-There will sadly 😪 be no hugs, handshakes 🤝 or any personal contact at this time and we will maintain proper social distancing except when not applicable to services being done. This makes me sad as I love to hug people, but it is necessary.
-There will be new COVID-19 paperwork added to your chart 📋
-Stepping into my office tells me, you knowingly and willingly consent to have tattoo services done during the COVID-19 pandemic. Please contact me if you at any time show symptoms of COVID-19. Please make sure I have a proper phone number for you as well, in case I would need to let you know the same.
Hygiene:
- After coming back to my room, personal items (phone, bottle) will be wiped down and you will be provided with hand sanitizer to cleanse your hands before we get started. This will be applied again after the consultation portion of your visit, right before laying on my chair which has been thoroughly disinfected and draped prior to your arrival.
-Please for continued hygiene purposes refrain from touching your mask and facial area in general. If a break is required for bathroom or a sip of water, we will readjust 😷and clean hands 🧼again before starting back up. Per usual procedure, avoid 🚫touching your tattoo area with your hands during the appointment.
-There will sadly 😪 be no hugs, handshakes 🤝 or any personal contact at this time and we will maintain proper social distancing except when not applicable to services being done. This makes me sad as I love to hug people, but it is necessary.
*******************
If you’re looking for more ways to protect yourself and your loved ones, check out the CDC website.
Thank you so much for sticking with me. 🥰 I look forward to supporting each other during these challenging times.
Chrissy ❤
#covid19 #safetyfirst
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