The day Carla Walker returned home after getting areola tattoos, she’d never felt more in control of her world. Despite the rough journey that led her to this moment—she’d been diagnosed with breast cancer in February 2019 and elected to have a bilateral mastectomy—Carla recalls looking at herself in the mirror and being overcome with a sense of both gratitude and empowerment

“The emotional side of dealing with breast cancer was staring me in the face. Every day, there was always a reminder,” she tells Glam. “Then I got my tattoos. I really could not stop thinking about how wonderful I looked and how happy having all of me back made me feel.”

Areola tattoos are becoming increasingly popular among women like Carla, who have undergone breast reconstruction surgery after cancer. And although a tattoo doesn’t change the cancer diagnosis itself, there’s hope and empowerment in knowing that breasts can be reconstructed, and that the appearance of areolas can be restored.

Whether you are considering nipple reconstruction tattoos yourself or would simply like to learn more about the empowering process, below you will find everything there is to know about areola tattoos, as well as before-and-after photos and areola tattoo ideas.

What is an areola tattoo?

Areola tattoos are exactly what they sound like: semi-permanent pigment tattooed on the breast to replicate the appearance of a nipple and the surrounding, often slightly more pigmented skin known as the areola. While areola reconstruction tattoos can be simply described as artfully placed ink, the results are shockingly realistic and pack an incredible amount of power.

After a mastectomy and/or breast reconstruction surgery, which typically occurs in cases of breast cancer or trauma to the breast, many people are left without a nipple or areola. Others are often left with their nipples intact, but may have scars or misshapen areolas as a result of surgery. This is where areola tattooing comes in.

“For those who would like to complete their reconstruction by restoring the natural appearance of their nipple-areola complex, there is a non-invasive, non-surgical option: paramedical micropigmentation,” says Dr. Starr Mautner, breast surgical oncologist with Baptist’s Health Miami Cancer Institute. The technique can be used to create a completely new nipple, or to enhance what’s there by evening out the shape, size, and color of the areola.

Read More: These ‘Roll Flower’ Tattoos Celebrate The Beauty Of Fat Bodies

Areola Tattoos
Adobe Images

Dr. Mautner explains that though they are similar, paramedical micropigmentation (aka areola tattooing) isn’t exactly the same as a traditional ink tattoo, since those usually contain metal fragments and would prohibit future necessary MRIs for cancer screenings. Aside from that very important detail, the process itself is very similar to getting an actual tattoo.

“At Miami Cancer Institute, our artist is able to support the work of reconstructive plastic surgeons by replicating the natural color and shape of a nipple and areola with custom-mixed pigments that resemble natural skin tones with a high degree of realism,” Dr. Mautner says. “Working with light and shadows, she is able to create the appearance of a nipple where there is none. This illusion of protrusion is also known as a ‘3D nipple tattoo.’”

(Dr. Mautner is referring to Suzanne Moe, a paramedical restorative tattoo artist who works at Miami Cancer Institute and owns her own studio, SUMA INK. She specializes in 3D nipple/areola tattoos for breast cancer survivors who have undergone mastectomy or breast surgery, and is the artist who worked with Carla after her surgery.)

Read More: Women Are Getting Nipple Injections To Make Them Look More ‘Designer’

The hyper-realistic results are seriously impressive, too: The nipple appears to protrude, the ring of pigmented skin surrounding a nipple has a natural-looking gradient effect, and the skin seems to pucker and look slightly bumpy on the surface as it normally would. The art is truly a masterful fusion of artistry, technology, and dedication to improving lives. (Scroll on to see for yourself.)

Before and After Photos: Areola Reconstruction Tattoos

What’s it like to get areola tattoos?

To get a better idea of what it’s like to get an areola tattoo—or more specifically, paramedical micropigmentation—we asked Carla to walk us through the process from beginning to end.

“Upon arriving at Baptist Health’s Miami Cancer Institute, I went into a procedure room where I met the artist who’d complete my 3D nipple and areola tattoo,” she recalls of her experience. “We had spoken on the phone several times before meeting in-person, so there was no apprehension as to whether we would click. I also had shared with her photos of my original breasts pre-bilateral mastectomy.”

From there, the artist transferred the rendering she had drawn of what would soon be Carla’s new nipples and areolas onto her breasts. Before starting the tattoos, Carla was able to look in the mirror to approve the rendering. Each areola tattoo is completely customized to the client, based on their desired results and other factors like scar patterns.

“Next, I laid on a table underneath a warm lamp and the tattooing process began,” Carla continues. After drawing the outline of the areola, the artist uses an oscillated tattoo needle or medical-grade cosmetic tattoo machine (if there is scar tissue) to transfer non-toxic pigment into the outer layer of skin. Because of the attention to detail, the entire process can take over two hours.

“After she finished this ‘masterpiece,’ we looked in the mirror and a huge smile spread across my face. It was a sense of landing back in my space—being whole and feeling full and complete,” Carla recalls rather emotionally.

Read More: What You Need To Consider Before Getting Breast Implants

Do areola tattoos hurt?

As with all tattoos, it really depends on your pain tolerance. Due to the typical sensitivity of the area, some say areola tattooing is more painful than other areas of the body. However, many women who have undergone a mastectomy experience loss of feeling in the area and as a result, report little sensation during the process. In this case, you may feel some pressure, tingling, and/or vibration as the needles transfer pigment into the skin.

How much does areola tattooing cost?

The cost of an areola tattoo will vary from artist to artist and often depends on factors like design details, the extent of scarring to be covered, and whether you need one or two tattoos. If you are paying out of pocket, it can cost anywhere from $600-$1500 for two nipple tattoos. But in many cases, both breast reconstruction and paramedical micropigmentation are covered by insurance when done by a healthcare provider; check with your insurance provider to see if you meet the criteria.

Read More: Women With Breast Cancer Courageously Walk Runway In AnaOno Lingerie

nipple tattoos

What you should know about getting areola tattoos in non-medical settings

There’s a growing trend of getting areola tattoos in non-medical settings, such as tattoo parlors and cosmetic tattoo studios. The formal recommendation is to get an areola tattoo using specialized, non-metallic ink in a stringent setting. However, this isn’t a possibility for some people, and in some cases, areola tattoos may be desired for reasons that may not be covered by insurance.

In cases where someone feels their existing pigment is too light, for trans people who’ve just had a top surgery and/or reconstruction, or those who’ve experienced trauma to the breast such as third degree burns, skin grafts, or other scarring, seeking nipple reshaping or re-pigmentation at a cosmetic tattoo studio is an A-okay option. Just be sure to find a highly reputable artist who has experience in cosmetic tattooing, preferably with a portfolio of nipple tattooing. (We also recommend speaking with your doctor first.)

Shaughnessy Otsuji, the owner and artist of Studio Sashiko in British Columbia, Canada, helps these kinds of patients often. “The visual and emotional impacts that areola tattooing can bring are so important,” she tells Glam. “This type of tattooing offers so much healing for someone who has experienced a drastically altered appearance. Being able to reconnect with your previous self when you look in the mirror is a magical thing. I am always so honored to be able to help restore these features.”

Otsuji uses the same technique for areola tattooing as she does for traditional tattoos, though additional, specialized care and attention is needed when working with scarred or otherwise compromised skin. “The colors I use are also a lot more natural-looking, such as pinks, browns, and other neutrals, as opposed to some of the vibrant pigments and darker blacks and greys used in other types of tattooing,” she says.

“I strive to create the most realistic results by adding strategic details, highlights, shadows and dimension, and by choosing a collection of colors that suits each person’s skin best. The end result is an undetectable, realistic areola that looks like one they would have had naturally.”

Other areola tattoo ideas

While most people opt for areola reconstruction tattoos that look natural, there is a growing trend for nontraditional areola tattoo designs like nipple tattoo flowers, areola tattoo hearts, and nipple ornaments. Though the approach is different, the designs are no less detailed and offer a more playful approach to covering scars. Scroll through some tattoo design inspiration below.

You might also like: This Woman Got A Tattoo In Response To Rude Comments About Her Skin Condition