In 2015, Rebecca Blizzard was about to begin a new chapter of her life in more than just one way. The year she turned 40 was the same year she chose to follow the cancer screening guidelines for detecting cancer early. After scheduling a visit with her doctor for her first-ever mammogram, results showed something wasn’t right. She went for a biopsy. It was breast cancer.
In June 2016, she had a lumpectomy at Anne Arundel Medical Center (AAMC) followed by six weeks of radiation therapy to lower the risk of her cancer coming back. It wasn’t until a few months later that she would find out she tested positive for BRCA2, sometimes referred to as the “breast cancer gene.” Rebecca proceeded with the removal of her breasts.
“At this point I didn’t want to take any chances, so I decided to have a double mastectomy,” she says.
Her doctor referred her to Anne Arundel Medical Group (AAMG) Plastic Surgery for options regarding breast reconstruction. “After hearing all of my options, I chose a DIEP flap reconstruction,” Rebecca says. “That’s where I learned about the nipple tattooing procedure since my nipples could not be saved.”
A new option
AAMC’s Chief and Medical Director of Plastic Surgery Devinder Singh, MD, and Virginia “Ginny” Lobach, M.S., PA-C, informed Rebecca about breast reconstruction options, including nipple tattooing. As an alternative to nipple areolar reconstruction, which requires surgery, this caught her attention.
“I was nervous about how another surgery would impact me,” she says. “I’m young and in my head, I didn’t want to not have anything. Ginny told me she recently trained to do 3D nipple tattooing, so I was all in for it.”
Whatever your age, relationship status or orientation, it’s hard to predict how you will react to losing a part of your breast. According to breastcancer.org, there are many feelings an individual can experience when giving up a part of the body that is a hallmark of becoming a woman – including anxiety, uncertainty and sadness. This is the reason Dr. Singh and Lobach wanted to bring 3D nipple tattooing to AAMG Plastic Surgery.
AAMG Plastic Surgery is unique in that it offers patients several innovative breast reconstruction options, including tissue expansion with Aeroform AirXpanders, pre pectoral implants, and microvascular deep inferior epigastric perforator flap (DIEP) procedures. 3D nipple tattooing is part of this comprehensive list.
“It gives normalcy back to a patient,” says Lobach, who started the clinic after taking a course to learn the 3D technique of nipple tattooing. “I think nipple tattooing is for the woman who says, ‘I don’t want to look at my breasts,’ and doesn’t feel comfortable in her own skin. I want to give back that comfort. I want to create a full breast.”
What is it?
3D nipple tattooing is done at the end of breast reconstruction after the nipple is removed during the mastectomy. It’s a noninvasive approach that Lobach performs in the office using a needle and pigmentation to create a 3D-looking nipple and areola. This approach creates an image of a nipple that feels flat to the touch but looks real.
“Tattooing is the least invasive, low-risk way of providing a patient with a complete breast,” Lobach says. “Nipple reconstruction has been around for a long time as part of breast reconstruction. Unfortunately, reconstruction means another operation taking skin from somewhere else to create an areolar and nipple, leaving additional scars. The nipple usually loses projection after a year.”
According to Lobach, the aesthetic results of nipple reconstruction are not as pleasing as a 3D nipple tattoo. “Working with the Rebecca Fortney Breast Center, we get to see many breast reconstructions that do not have the end result of an areola and nipple,” she says. “I saw that patients were not finished. And many were just OK with that result. They didn’t want to go through another operation. With 3D nipple tattooing, we are able to offer a completed breast reconstruction without another operation.”
Is it safe?
“Nipple tattooing is a safe technique and it’s always my patients’ choice,” Lobach says. “I want it to be an option so the patient can make their decision either way.”
Despite a lingering negative connotation attached to tattoos by some, a 3D nipple tattoo is a safe alternative to regaining a full-looking breast after a patient has been diagnosed with breast cancer.
There is a difference between the tattoo pigmentation Lobach uses and that of the one used at a tattoo shop. “I use an organic pigmentation made from lake salts,” she says. “I only like to use very safe products with very low risk of infection. It’s the same type of pigments that are used for cosmetic and facial tattooing. The pigment is a very soft and beautiful color. The patient also has a choice in the color we choose for tattooing.” Tattoo artists, on the other hand, often use metal-based pigments containing titanium, led or chromium.
3D tattoos are permanent but like any tattoo, will fade over time. Usually only one session is needed to create the tattoo, but an additional touchup session may be required over time.
When a person is diagnosed with breast cancer, it is one of the scariest times of their lives. It can change them completely, particularly physically. Once a person has beaten cancer, they can focus on rebuilding themselves emotionally and physically. “I feel like the tattoo gave me my confidence back, which I needed after everything that happened,” Rebecca says. “It made me feel more comfortable looking at myself in the mirror.”
