A mastectomy (breast removal surgery) sometimes requires complete removal of the nipple and areola. Seeing a blank piece of skin instead of a nipple can stir up a lot of emotions. “I don’t know if words can ever express what this horrible disease can do to rob us women of our femininity and self-esteem,” one MyBCTeam member wrote.

Getting a nipple tattoo after a mastectomy is a popular option that looks quite realistic. But is it right for you? This guide will explain the types of nipple tattoos available, what to expect from the procedure, and possible alternatives.

What’s the Difference Between a 3D Nipple Tattoo and Nipple Reconstruction?

Nipple reconstruction is a surgical procedure. A plastic surgeon cuts and shapes a flap of skin on your breast into a small cylinder.

To make the areola, the surgeon may cut skin from your inner thigh and graft it around the new nipple. Many people have a darker skin tone on the inner thigh, which may resemble the darker color of the areola. But if it doesn’t look natural, you can have a tattoo artist add color to the areola.

Alternatively, you can avoid the skin graft by getting the entire areola tattooed. The precise colors and shading techniques used make it look realistic. If you want, injectable fillers can also be used to create the appearance of a fuller areola.

If you’re not interested in surgery, consider a complete nipple tattoo. A skilled tattoo artist can make the nipple look 3D, like a photograph. The nipple itself will be flat.

What To Expect: Timing and Procedure

The rule of thumb is to wait at least three months after nipple or breast reconstruction surgery (if applicable) to get a tattoo. Your care team might advise you to wait longer if they have concerns about your health. Tattoos can slightly increase your risk of infection, so it’s important to avoid a tattoo if your immune system is still weak from cancer treatment or surgery.

In general, your scar tissue should look healthy and healed, your chemotherapy and radiation therapy should be finished, and you shouldn’t have any lingering side effects, such as lymphedema or infection, when you decide to get your tattoo.

A postmastectomy nipple tattoo usually takes two hours to complete. Some of that time is spent selecting colors and deciding where to place the tattoo.

The tattoo procedure can feel uncomfortable because small needles inject pigment under the skin. It might feel like poking or scratching. However, some people report that nipple tattoos are virtually painless because the breast area loses feeling after a mastectomy. You might just feel pressure or vibration.

If you’re concerned about pain, ask about numbing injections or numbing cream.

Nipple Tattoo Healing and Aftercare

It takes about two weeks to fully heal from a nipple tattoo. During the first few days, you’ll wear a waterproof dressing over the tattoo.

By day 4, you can take the dressing off, gently wash the tattoo, and apply a colorless, unscented lotion. Continue to apply this lotion at least once a day.

You may notice a scab forming over the tattoo. Leave this alone and let it fall off naturally.

Although it’s OK to take a shower, you should avoid soaking the tattoo for the first two weeks. That means no swimming, bathing, or hot tubs.

Limit your activity for the first week after a nipple tattoo. You can do physical therapy exercises, but don’t do anything more strenuous, including yoga, running, or cycling. Don’t lift anything over 20 pounds for the first week either.

Watch for signs of infection, such as pain, discoloration, warmth, or thick drainage around the tattoo. A fever of 101 degrees Fahrenheit or higher is also concerning. If you notice any of these symptoms, contact your healthcare provider right away .

Are There Risks Associated With Nipple Tattoos?

All tattoos carry some risks. Needles can be contaminated with bacteria or viruses, which may cause infections. Medical professionals and licensed tattoo artists are required to use sterile equipment to lower these risks.

Certain types of tattoo ink have potentially harmful ingredients, such as heavy metals and toxic nanoparticles. Some studies suggest that certain tattoo inks may contain carcinogens. Ask your tattoo artist what kind of ink they use.

Before getting a nipple tattoo, talk to your care team to make sure you’re a good candidate for the procedure. If breast cancer treatment caused thin or damaged breast skin or chest lymphedema, a nipple tattoo may not be right for you. A history of infections in your breast may also disqualify you from getting a nipple tattoo.

Touch-Ups and Long-Term Results

Nipple and areola tattoos may look vibrant and realistic at first but fade over time. To keep them looking natural, you may need an occasional touch-up.

The timeline for this varies, but some recommend a touch-up appointment within the first six to eight weeks. By this time, the color should’ve settled and the skin should be fully healed, so your tattoo artist can see if any immediate touch-ups are needed. After that, you may not need a touch-up for years.

Regularly moisturizing the tattoo may help prevent fading. If you plan to expose the tattoo to the sun, cover it in sunscreen first, as ultraviolet radiation speeds up the fading process.

Choosing What’s Right for You

Is a nipple tattoo right for you? That’s a highly personal decision.

Some people don’t feel complete or feminine without a nipple on their breast. Having a nipple can also distract from scars and may lessen the feeling of loss that can happen after a mastectomy.

If you want a nipple but don’t think a tattoo is right for you, consider a prosthetic breast or prosthetic nipple — these silicone products come in a variety of shapes, sizes, and colors. They include a raised nipple and textured areola, so you can also get the benefits of nipple reconstruction without surgery. Many are made with self-adhering silicone, but there are a variety of materials available.

Cost and health insurance coverage may also play a role in your decision. According to the Women’s Health and Cancer Rights Act, breast reconstruction surgery must be covered by insurance after mastectomy, but coverage for nipple tattooing varies by plan, state, and provider type. Tattoos can cost several hundred dollars or more for self-payers, but some charities offer free nipple tattoos after mastectomy.

Your care team can help you weigh the pros and cons of each option, including no nipple at all. They can offer you the right support at the right time once they know your preference.

Join the Conversation

On MyBCTeam, people share their experiences with breast cancer, get advice, and find support from others who understand.

What type of nipple tattoo are you considering? Let others know in the comments below.