Studying Applied Health Science has given me the opportunity to understand my patients journey from a different perspective as tattooing areolas really isn’t just about someone knowing how to tattoo. It should be more about them understanding the reconstructive process, wound healing, immunity, and other factors that affect breast cancer patients. Working with breast cancer patients as a Medical Cosmetic tattooist can be challenging but also rewarding and over the past seven years and I’ve come to understand from experience that each patient presents with their own physical and psychological story. Assisting the surgeons in completing the breast reconstruction process through the skilful application of colour in the form of nipple areola tattooing definitely provides most breast cancer patients with much needed emotional and physical healing. For many, it represents the end to a very stressful chapter in their lives but not to forget it’s not always the end of the journey for all patients as metastatic breast cancer (MBC) affects some of our patients. Throughout this article, we will touch on the psychological aspects of breast reconstruction including some of the surgical processes involved in mastectomy and breast reconstruction.

In recent times it has been a struggle with social media and community standards as to what is acceptable, as far as images of our work. Male breast images are acceptable however female breast images are not allowed and breach these standards. We know that the female breast has always been regarded as a symbol of femininity and our breasts are extremely important in our lives often forming an integral part of our physical and indirectly psychological sense of wholeness. Differences from “normal” size or shape are often perceived as unattractive. So, this is by no means just an aesthetic problem as these differences often have adverse long term effects on body image, emotional well-being and can significantly reduce a woman’s self-esteem and quality of life.

Thankfully, our plastic surgeons have always been aware of this problem and have attempted to develop appropriate surgical measures to address it. Along with advances in surgical techniques, silicone breast implants have contributed significantly to improvements and all surgical measures have the common goal of improving the appearance of the breast to conform to what the patient finds aesthetically pleasing, and of course the patients’ perception of her-self is of vital significance. Changes may involve reducing the size, altering the shape with- out reducing substance, enlargement or establishing symmetry. In reality it is not always possible to satisfy every patient through surgical techniques and this is where the medical cosmetic tattooist can work closely with a surgeon and through the skilful application of colour can assist the surgeon to satisfy an individual patient’s requirements to achieve a positive outcome.

The indications for each surgical treatment are based on different assessment criteria. Often for the patient, breast asymmetry can be a significant cosmetic problem and may result in psychological distress. Treatment may be provided due to either aesthetic or psychological reasons. One example would be a patient may suffer from physical complaints due to abnormally large breasts that particularly cause pain in the breast and back. The indications for breast surgery are based on various assessment criteria, and it should be mentioned that aesthetic breast surgery is not the same as “cosmetic surgery, “even though breast enlargement with silicone implants is regarded a form of cosmetic surgery.

In the treatment of breast cancer, increasing attention is being given to psychological and aesthetic factors, provided they do not compromise oncological safety. Such factors were ultimately responsible for the development of breast conserving surgery. Two-thirds of breast cancer patients now benefit from the use of breast-contouring techniques. However, approximately one- third of patients have to undergo (modified radical) mastectomy so reconstruction should form part of the treatment plan from the beginning. Modified radical mastectomy is defined as a total mastectomy, which is complete removal of the mammary gland, including the nipple-areola complex. The skin envelope, including the pectoralis fascia, is preserved for primary wound closure. The advantages of implant reconstruction are the short amount of time required to complete the reconstruction and the avoidance of additional scarring or a donor-site defect. Implant placement differs considerably between immediate and delayed reconstruction. In primary implant placement, complete muscle coverage should be obtained, since the post mastectomy skin flaps are unable to provide stable coverage for the implant. However, in recent times with the advent of Acellular Dermal Matrix, plastic surgeons have the option to consider using ADM where patients don’t require LD or DIEP flap coverage. ADM is a specialised surgical mesh or prosthetic mesh that is used to create a sling within the chest that cradles the implant and is created from using biological, alloplastic human or animal.

The good news is that women who have had implant-based breast reconstruction report that they no longer feel deformed as they did following mastectomy and that they feel more normal and less depressed about their appearance. They also report that breast reconstruction with breast implants aided their recovery from breast cancer and reduced emotional stress by helping to restore the body to a more natural appearance. Remembering, that woman who undergo breast reconstruction often don’t retain their own nipples or areolas. In this instance a medical cosmetic tattooist can recreate a natural looking nipple and areola complex and from personal experience I know this final step often benefits not only the patient’s physical appearance but also aids in their emotional recovery.

References
http://www.breastreconstruction.org/SecondaryProcedures/NippleAreolaReconstruction.html
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4115772/
http://www.breastcancer.org/treatment/surgery/reconstruction/types/implants/what-to-expect
http://www.mayoclinic.org/tests-procedures/breast-reconstruction/basics/what-you-can-expect/prc-20020485
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4115772/

Journal:
EMedicine-Medscape.com Breast Reconstruction, Nipple Areola Reconstruction
Yoon Sun Chun, MD, Clinical Instructor, Department of Surgery, Harvard Medical School; Associate Surgeon, Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham and Women’s Hospital; Staff Surgeon, Department of Surgery, Division of Plastic and Reconstructive Surgery, Faulkner Hospital
Dennis P Orgill, MD, PhD, Professor of Surgery, Harvard Medical School; Associate Chief of Plastic Surgery, Brigham and Women’s Hospital

Breast Reconstruction after Mastectomy 2014 Copyright American Cancer Society

Book:
Gabka, C J Bohmert, H & Blondeel, P N (2009) Plastic and reconstructive surgery of the breast Stuttgart: Thieme

Christine Comans

Christine Comans is a qualified and highly respected cosmetic tattooist based in Perth who specialises in medical cosmetic tattooing. Her work is highly regarded by several plastic surgeons who keep her busy through constant referrals of their patients.

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