For many breast cancer survivors tattooing may be the final step in their breast reconstruction journey. This often involves creating the illusion of protrusion through the skilful design and application of colour performed by an experienced medical cosmetic tattooist.


Sadly one in eight women will develop breast cancer in their lifetime and on average 47 women, every day is diagnosed with breast cancer in Australia.

Did you know that age is one of the risk factors for developing breast cancer, and more than two in three cases of breast cancer occur in women aged between 40 and 69 years?

Early detection is the key, and it is attributed to improved survival rates through regular screening combined with improved treatments outcomes. All that said we still have on average seven women in Australia that die from breast cancer every day.


Nipple areola tattooing is the final step in the breast reconstruction process, and for many women, it will be the very last procedure they undergo to complete their whole breast cancer and reconstructive journey. Some patients feel they have been through enough and just don’t want to have further surgery and choose not to proceed to have a reconstructed nipple. While others women want to have everything returned to the way they were before breast cancer, this includes nipple reconstruction and re-colouration of the nipple areola complex.

There are several options when it comes to re-colouration of the areola complex. Some women choose the non-surgical option of cosmetic tattooing and proceed without nipple reconstruction and speaking from a medical tattooist’s point of view this provides me with the opportunity to use my skills to simulate or recreate protrusion of the nipple areola without the contour of an actual nipple. While other patients undergo nipple reconstruction and the medical tattooist simply completes the reconstruction by adding a final touch of colour, providing realism and texture.


Areola tattooing is specialised work which means most industry professionals should work on referral from the plastic and reconstructive surgeons and hospitals and maintain high clinical procedural standards, continued education and training, embrace advancing techniques and possess a natural ability to show empathy and compassion to provide the best outcomes for all patients.

What’s in the bottle? There are serious concerns over body artists providing areola tattooing to breast cancer survivors, and these concerns come from the tattoo inks being used. Body tattoo inks have been found to contain carcinogenic compounds in the form of azo dyes with the bonus of bacteria. Now we all know body tattoos are in popular demand as a fashion item and body tattooists can be very artistic however serious considerations should be made as to why medical tattooing should only be provided by well-trained cosmetic medical tattooist.

In 2014 there was a recall of body tattoo inks across the world, and regular testing of body tattoo inks continues to unearth bacteria in the bottles. Until the testing proves otherwise, I don’t agree with implanting body art pigments into a person that has undergone mastectomies, adjuvant therapies and reconstructions especially when these women have already had a battle with cancer and their immune system is often compromised.

Nipple Areolar Reconstruction - before & after


Pick your practitioner carefully as only certain cosmetic tattoo pigments undergo rigorous testing. Resolution ResAP (2008) on requirements and criteria for the safety of tattoos and permanent makeup provides a requirement for testing of cosmetic tattoo pigments it includes a list of negative substances that should not be present in cosmetic tattoo pigments, these include colourants and aromatic amines, as well as the maximum concentrations for some impurities. The recommendation also provides the criterion for the safety assessment of the used chemicals and encourages establishing a positive list of substances proved to be safe for their use under certain conditions.


As you can see, there are a few things that must be considered before you undergo any cosmetic procedure. Medical tattooists must have artistic and technical competence with a good understanding of the appearance, variations and structure of the areola. It’s important that the technician has an adequate understanding of the different types of reconstructive surgeries that they may encounter as well as sound knowledge of the reconstruction process affording the patient a high level of satisfaction with the outcome of their nipple-areola complex tattoo.

Nipple-areola complex re-colouration is usually reserved as the final step in the breast reconstruction process and is critical for providing an aesthetically pleasing breast. Patients with loss of the nipple and areola continue to experience psychological distress even long after breast reconstruction has taken place. Following mastectomy and breast reconstruction, nipple-areola complex re-colouration can provide significant psychological benefits to the client.


Completion of the breast reconstruction by performing a re-coloration procedure that gives the appearance of a realistic nipple-areola complex concerning symmetry, size, shape, colour and position adds significantly to the reconstructive result and satisfactory outcomes for all involved. However, most importantly, re-coloration of the nipple-areola complex has a high impact on overall patient satisfaction and acceptance of body image post procedure.

Christine Comans

Christine Comans is a highly respected cosmetic tattooist, trainer and educator based in Perth who specialises in medical cosmetic tattooing. Chris is a strong advocate for industry standards and is renowned for her love of learning and sharing her knowledge.

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