The What, How, and Why of Post-Op Tattoos

Patient Expert

Credit: Heidi Wagner Photography for P.ink

If you have been diagnosed with breast cancer, you may have a tattoo in your future, as breast cancer patients often get tattoos for both medical and aesthetic reasons. While most tattoo procedures don’t cause problems, you need to take care to stay safe. And although breast cancer patients and survivors will need to arm themselves with lots of information and a long list of questions for any prospective tattoo artist, both medical and decorative tattoos can be a key part of the healing process.

Why get a tattoo?

Tattoos are routinely used in radiation therapy and for nipple reconstruction after a mastectomy, as well as for symbolic reasons.

Credit: Heidi Wagner Photography for P.ink

Medical tattoos for radiation. It is essential that radiation therapy be applied to exactly the same place at each session, so often the radiation oncologist will place tiny pinpoints of ink under the skin surface to indicate the area to receive radiation. My radiation oncologist uses a combination of tattoos and permanent marker lines to outline the area. I still have six dots on my chest 18 years later. If you have religious objections to tattoos, your radiation oncologist can probably make do with permanent marker or henna, but you will need to be very careful not to let them wash off.

Nipple reconstruction tattoos. Sometimes women with a low risk of recurrence can have a nipple sparing mastectomy, but nipple reconstruction is part of the process for most women who have reconstruction surgery. A tattoo that creates an areola and nipple the same color as the original is the goal. Some tattoo artists, like former Army medic Vinnie Meyers, specialize in creating realistic tattoos for breast cancer survivors.

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Credit: Artist Erin Torola

Possible complications

If you are considering a tattoo, there are possible problems to keep in mind ranging from infection and allergic reactions to complications in imaging tests in the future.

Infection or allergic reactions_._ You may want to postpone any tattoos while you are on chemotherapy, radiation, or any other treatment that compromises your immune system. A tattoo pierces the surface of the skin, so infection is always a possibility. Even after your immune system is healthy again, following the directions for keeping the area clean is a crucial step for a successful experience. If you have a history of allergies, ask questions about which inks are the best for you.

MRI complications. Tattoo inks often contain iron oxide or other metals that might cause problems with MRI machines. If the design has loops that intersect, an electrical current can be created during the MRI process that can cause burns. Even if the patient doesn’t experience problems during the MRI procedure, tattoo pigments can cause the image to be blurry. These problems are rare, and the technician doing the MRI can use a cold compress to reduce the possibility of a burn if you mention your tattoos ahead of time.

Migration of ink to lymph nodes. Even rarer than MRI complications is the possibility that tattoo ink may be mistaken as a metastasis of cancer. (There is at least one recorded instance of a woman being treated for cancer in her lymph nodes that was actually tattoo ink that had migrated there.) If you have numerous tattoos, there is a possibility that some of that ink has spread to other areas of your body and that the ink might cause confusion on imaging tests.

Before you tattoo

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Credit: Heidi Wagner Photography for P.ink

Think before you ink. Tattoos are permanent. Spend some time living in your post-cancer body and processing the experience. Are there special symbols that have significance for you now? What parts of your body bother you the most? Would a tattoo help you heal? While you wait for your immune system to get strong again, give some thought to whether a tattoo is right for you. Discuss the decision with your surgeon and oncologist to make sure you have considered all the medical issues involved.

Get information about the artist you might use. Be sure the tattoo artist is fully licensed in your state. Ask what types of certifications and professional memberships the artist has. The Mayo Clinic has a good list of safety precautions the tattoo artist should use, such as wearing protective gloves and fully sterilizing all equipment. Ideally, the person should have worked with cancer patients before and understand the health and emotional issues involved in tattooing a breast cancer patient.

Before you schedule the actual tattoo procedure, make time for an interview. Ask questions about the sanitation procedures used, as well as what types of inks will be involved. Ask about designs that do not use metallic inks which could cause problems with an MRI. If your tattoo artist has never heard about issues with metallic inks and MRI machines, find a different artist. If you don’t feel completely comfortable with the artist, keep looking until you find someone who has high sanitation and artistic standards.

Artist

Andy Howl

Be scrupulous about post-tattoo care . Before you get the tattoo, make sure you understand restrictions you may face afterwards. You may need to avoid swimming and physical activity that would rub against the area, so you don’t want to schedule your tattoo session the day before a beach vacation. You should probably allow about two weeks for healing. Follow the directions you are given exactly for follow-up care, and contact your doctor promptly if you see any indications of infection.

See More Helpful Articles:

Life After Mastectomy: Nipple Reconstruction

Radiation 101: Your Guide to Radiation.

Twelve Tips for How to Prepare for Getting a Tattoo

Sources:

Breast Reconstruction after Mastectomy. National Cancer Institute. February 12, 2013. Accessed from http://www.cancer.gov/types/breast/reconstruction-fact-sheet May 9, 2016.

Kim, E. Meet the Tattoo Artist Making Breast Cancer Survivors Feel Whole Again. Today Health and Wellness October 19, 2015. Accessed from http://www.today.com/health/meet-tattoo-artist-making-breast-cancer-survivors-feel-whole-again-t48276 May 9, 1026.

Kylstra, C. 13 Powerful Photos of Mastectomy Tattoos. BuzzFeed Life. Dec. 18, 2014. Accessed from https://www.buzzfeed.com/carolynkylstra/mastectomy-tattoos?utm_term=.qmD3NJd6RN#.dwQQLkMR4L May 9, 2016.

Mulcahy, N. Tattoos Mistaken as Cancer Metastases: Surgery Performed. Medscape Medical News June 15, 2015. Accessed from http://www.medscape.com/viewarticle/846409 May 9, 2016.

Nipple AreolaTattoo. BreastReconstruction.org. Accessed from http://www.breastreconstruction.org/SecondaryProcedures/NippleAreolaTattoo.html May 9, 2016.

Radiation Therapy for Breast Cancer: How You Prepare. Mayo Clinic February 13, 2014. Accessed from http://www.mayoclinic.org/tests-procedures/radiation-therapy-for-breast-cancer/basics/how-you-prepare/prc-20013445 May 9, 2016.

Ross, J. and Matava, M. Tattoo-Induced Skin “Burn” During Magnetic Resonance Imaging in a Professional Football Player: A Case Report. Sports Health September 2011. Accessed from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445217/ May 5, 2016.

Tattoos: Understand Risks and Precautions. Mayo Clinic Adult Health March 6, 2015. Accessed from http://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/tattoos-and-piercings/art-20045067?pg=1 May 5, 2016.