Areola micropigmentation after a mastectomy

Areola micropigmentation is usually the last thing anyone tells you about. Reconstruction gets discussed at length, and then at some point months or years later somebody mentions in passing that the areola is done separately, by a tattooist, and often not on the NHS.

By that stage most people are tired of medical appointments and are being asked to make yet another decision, this time about something cosmetic, from a standing start. This is written to give you the questions worth asking, so that when you do speak to somebody you are choosing rather than being sold to.

Be clear what it is

It is tattooing. Pigment is worked into the skin and shaded so the area reads as having dimension rather than as a flat disc of colour. Where you have a remaining side, that is what the colour and the size are matched to. Where both sides are being done, they are worked together so they match each other.

It is not surgery, it does not rebuild anything, and it will not restore sensation. What it does is finish the visual part of something that has otherwise been finished for a while.

A great many people describe that as the point at which they stopped seeing a surgical result in the mirror. That is a reasonable expectation to hold. Anything beyond it is not.

Who actually does this work

Three groups, and they are not the same.

Specialist medical tattooists. People whose practice is largely or entirely restorative. Usually the most experienced with skin that has been through surgery and radiotherapy.

Permanent makeup artists who also take on restorative work. A smaller group. What matters here is how much of it they actually do, not whether it is listed on their website.

Some NHS trusts and private clinics, sometimes through a nurse or a specialist attached to the breast unit. Worth asking your breast care nurse about first, because if it is available to you locally it may cost nothing.

Start with that last one. It is the question people most often forget to ask, and the answer is sometimes yes.

Questions worth asking

How much of this do you do?

Not whether they offer it. How often. There is a meaningful difference between somebody who does this most weeks and somebody who has done it twice.

Can I see healed work, not fresh work?

Fresh tattooing always looks impressive. Healed work is the only honest evidence, and on skin that has been through surgery the healed result can differ considerably from the day it was done.

Many artists will not publish this work publicly, for obvious reasons, and that is not a red flag. Being unable to show you anything at all in private is.

What has my surgical team said about timing?

Ask them, not the tattooist. How long to wait depends on your surgery, your healing and whether you have had radiotherapy, and it is a clinical question rather than an artistic one.

Any tattooist who is willing to book you in without asking what your team has advised is telling you something about how they work.

How will scarred or irradiated skin behave?

Differently, and less predictably. It may hold pigment unevenly, take more than one session, or fade faster in places. A good practitioner will say this before you book rather than after.

How many sessions, and is that included?

Almost always more than one. Establish before you start whether the quoted price covers the follow-up work or whether each session is charged separately.

What happens when it fades?

It will, like any tattoo. Ask what refreshing it involves and what it costs, because that is a conversation for a few years' time and you want to know now.

Practical things people wish they had known

• The colour looks considerably stronger for the first few days and softens as it heals. It is meant to.
• You will be asked to complete a consultation covering medical history and medication, the same as any tattooing.
• A patch test is required in advance, and it has to be a separate visit.
• It is worth asking about privacy at the studio. Somebody working alone with no reception and no other clients in the building is a very different experience to a busy salon.
• You do not have to decide anything at the first conversation, and you should be suspicious of anyone who wants you to.

If you are not ready

That is a legitimate answer and it stays available indefinitely. There is no window that closes. Some people do this a year after surgery and some do it eight years after, and the second group are not late.

The only genuine deadline is the clinical one about when your skin has healed enough, and that is a question for your team rather than for a website.