A year and a half after Francis, 58, was diagnosed with breast cancer, a nipple tattoo appeared. She’s tired of chemotherapy, hormone therapy and operations, but she’s also happy that her breast reconstruction is coming to an end. “I was a little nervous, because I had never done a tattoo before,” she tells RTL Nieuws.
Frances was referred to a nurse performing medical tattoos at the hospital where she was being treated at the time. “She’ll specialize in getting nipple tattoos,” says Francis. But upon entering it, I immediately felt an unpleasant feeling.
“I was treated very unkindly. I showed pictures of my natural breasts, so as to serve as an example of the color of my nipples. My God, they are huge, said the nurse, I made them small much earlier.”
Francis was in pain getting the tattoo, but the nurse didn’t understand much. “She said I should be glad I felt the pain because many women don’t feel it at all anymore. I came home feeling unhappy, but I also thought: At least there’s some color on it again.”
The color faded
With a nipple tattoo, pigment or pigment is applied under the skin in the original color of the nipple and areola. For many women, getting one is the last hurdle in the process of contracting a serious illness and the idea is that the tattoo will last a lifetime.
Francis also hoped this would be the end, but the color of her tattoo faded after only a year. “And I’ve also heard from other women that tattoos fade quickly.” I tried again, this time with a plastic surgeon. But again without success. Three years later, she disappeared again. I was disappointed. She felt like she couldn’t “completely let go” of her disease process right now.
Ellen, 61, of Twilo, was also unhappy with her nipple tattoo. I got the first in 2011 and the second in 2016. “But the medical tattoos faded again and again after three to four years.” Like Frances, she was referred to a nurse after her breast reconstruction who, in Elaine’s eyes, “did her best to get as good a tattoo as possible, but had little experience”.
Cherry on the cake
She wished she had been better informed about the different options for getting a nipple tattoo, such as having a 3D areola. This is a tattoo that is done in such a way that it has a 3D effect. “A nipple has a huge impact on your self-esteem. You may not always think about it, but you see it in the mirror every day. It’s really the icing on the cake, those nipples.”
The fact that many women are unhappy with tattoos on their nipples is something they also noticed at the Icazia Hospital in Rotterdam. Since the summer of 2019, they have had a private outpatient clinic for nipple tattoos. So far this year, 238 breast cancer patients have been reported, many of them women who got their first tattoo elsewhere. At the TB Medical clinic, with which Icazia works closely, hundreds of patients have been treated again in the past year, a total of 678.
Plastic surgeon Dirk Jan van der Avort has been involved in the outpatient clinic at Icacia Hospital since the beginning. He says breast cancer patients come to the hospital from all over the country. “It really took off last year.”
As a plastic surgeon, van der Avort is involved in breast reconstructions and thus experiences first-hand how important nipple tattoos are to women. “If a woman has breasts again after a very difficult journey, she feels like a woman again. But if that is ruined by tattoos that come across as being unhappy with her, she becomes very sad. It is very difficult psychologically that having to Living with an ugly nipple.”
Medical tattoo artist Ralph Moelker performs a nipple tattoo on an outpatient basis at Icacia Hospital. Moelker uses proprietary 3D and tattoo techniques to create depth and relief in the nipple. “I tattoo my nipples permanently,” he says. “I don’t use medicated ink, like a dermatologist does. It makes the tattoo fade faster. I apply it better, because of my background as a tattoo artist.”
Lack of information
Molker stresses that medical tattoos are also doing well in “some hospitals”, but the large number of dissatisfied patients is driving this. “Because of the lack of information on how to properly apply this, patients sometimes walk around with this for years.”
A number of hospitals in the Netherlands, such as Anthony van Leeuwenhoek Hospital, Maxima Medical Center and Isala, also hire medical tattoo artists. This is the person who specializes in tattooing the nipples of women with breast cancer.
“There’s a big difference between regular tattoos and medical tattoos,” Mulker says. “You get a regular tattoo in a tattoo shop of your own free will. With medical tattoos, patients are informed by a hospital or a professional. There are a lot of patients who will never get a tattoo.”
According to him, things often go wrong at other hospitals and dermatologists due to a lack of control over the quality of medical tattoos. “The doctor refers someone, but then he withdraws his hands. That has to change. If the woman is not satisfied, the doctor should talk to the person who got the tattoo.”
The lack of this control has consequences for quality. “The government should give a quality mark to people who apply medical pigmentation. There are now too many practitioners in the business, including in hospitals, who cannot guarantee a good end result.”
What also plays a role is that Moelker gives a lifetime warranty. “If you have a tattoo that a dermatologist puts on and it fades, you have to pay again for the treatment. I think that’s overrated, also because I’ve experienced it myself. I feel it.”
Through other women’s stories, Elaine eventually ends up in Icacia Hospital, and Ralph helps her. “I’m more satisfied with the result now,” she says. “The tattoo is a 3D construction. Visually it looks like a nipple. It has a lot of shadow in it, so it doesn’t look like a flat thing anymore.”
Francis also got a new nipple tattoo at Icazia Hospital. “From the moment I walked in, it felt so good. In addition to the color staying on, Ralph did it in such a beautiful way, with such a beautiful relief, and I thought: Wow, it’s true. I really love it amazing.”
closing the disease process
Van der Avort believes it is important that there is greater awareness of nipple tattoos. “It is important for women to know that nipple tattoos can be applied in different places in the Netherlands, there is a choice. Women think they have to be content with what they get in the hospital, but this is not the case.”
Frances shares her story with other women going through the same thing. “To show that you’re not a whiner, because you want a nice tattoo on your nipple,” a sentiment she had in the medical world. Because in the end she found a good place to get the tattoo, but it took years of patience and a lot of perseverance.
“It’s like I can now end the disease process and let it go. And I can look in the mirror with a certain pride again. I feel like a woman again.”
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