In March 2015, I was handed a folder — the contents of which would change the course of my life. I learned I had inherited a BRCA mutation, which increases one’s risk of breast, ovarian, and pancreatic cancers exponentially. Though not given a cancer diagnosis, I was told my lifetime risk of being diagnosed with breast cancer was 87%. Immediately, I consulted breast surgeons to understand my options: surveilling my breasts through biannual scans or undergoing a preventative double mastectomy. I chose the latter.
Years ago, the techniques and tools used during plastic surgery were not as advanced as today and we knew less about how cancer cells weave their way through the body. As a result, individuals who underwent mastectomies — the removal of all breast tissue from collarbone to the middle ribs, underarm to underarm — were robbed of their breasts and their nipples, leaving two scars slashed across the chest as a permanent reminder of their disease and their pain. Until recently, many were also left flat after surgery. The cost of reconstruction, once considered an elective cosmetic procedure, was bore by the individual. So they went nippleless and flat, robbed of the thing society has made a necessary factor to their womanhood.
Now, mastectomies are done differently, with nipples spared for many and reconstruction an option that won’t bankrupt the patient. But still, the procedure itself changes the body forever. It’s not uncommon to feel detached from your reconstructed chest, which is why many people opt to tattoo their chests after mastectomy, masking their scars, but not necessarily their pain, with ink and designs that allow them to heal in a new body.
The tattoos vary. Some people opt for bold, colorful designs that span their entire chest. Others tattoo a single side, often one where their nipple was not spared. Then there were those who travelled to the United States to visit Vinnie Myers in Maryland. The tattoo artist stopped doing custom, colorful designs in 2001 after learning 3-D nipple and areola tattoos offered by plastic surgeons were limited in color and technique. He’s since tattooed thousands of people after their mastectomies and trained other artists in the technique.
Social media has been a catalyst in how people, especially breast cancer patients, learn about their reconstruction options. Although Facebook and Instagram have policies that allow photos of breast cancer patients and reconstruction for educational purposes, the photos are still deleted and accounts suspended — perhaps a testament to how real-looking the reconstructions patients are receiving are. However, the photos that are rarely flagged are the ones where patients are showing their mastectomy tattoos.
Since undergoing my own preventative double mastectomy in October 2015, I’ve used social media to engage with people like me who have experienced the same trauma, and this assault on their body and identity. The most empowered in this group are often younger, using their experience to help others. Samantha Malamet started the Instagram account Topless Yoga to document her experience through images and movement. “I was embarking on new territory as to what I could do physically after a double mastectomy and reconstruction,” she says. “I was very active… doing yoga, and I didn’t really know if all of this was possible after.” Malamet, who is a 30 year-old anesthesia resident, was diagnosed with stage 3 triple negative breast cancer in 2015. The nature of her diagnosis meant one of her nipples needed to be removed during her mastectomy as well. After her first surgery, where tissue expanders were placed to prepare her chest for permanent implants, she went through radiation and then, eight months later, she had her exchange surgery to replace the expanders for implants.
Plastic surgeons offer nipple reconstruction to patients who lose one or both of theirs during the mastectomy, but Malamet decided against it. “I thought that if I was trying to recreate something that I love, I would always have been disappointed with the results,” she continues. Instead, nearly three years after her final surgery, Malamet worked with artist Madison McLain of Sanctuary Tattoo Gallery in Madison, Wisconsin to create a design that, she said, “could be part of my healing and instead of missing what is no longer there, now I have something new.”
McLain had only done two mastectomy tattoos prior to Malamet’s — one was a custom design and the other was a nipple and areola tattoo — and she considers it a huge honor. The latter was “a really awesome experience because the woman brought a lipstick of the color nipple she wanted. We mixed and recreated the exact color for her.” Although most of the women she’s tattooed are not shy or self-conscious, McLain does these tattoos in a private room or, at least, uses sheets or dressing screens to make sure her clients are comfortable. Mastectomy tattoos, like any scar cover-up, take more time. “We don’t go as deep and we pull lines slower. When you are tattooing scar tissue, it has a combination of thick and thin skin in a matter of a few centimeters and so has to be worked with carefully.”
Meg Gallagher underwent a preventative double mastectomy in 2014 when she was 26 and although she did not have a cancer diagnosis, she was unable to have a nipple-sparing surgery. Like Malamet, she knew her breasts were never going to look “completely normal” again and decided early on against reconstructed or tattooed nipples. “This was reinforced when my first plastic surgeon left me with some pretty rough scars, which have since been corrected. Now I don’t necessarily want to cover my scars. I want to enhance them by illustrating how I feel about myself since going through this process: powerful, unstoppable, relentless — so I’m going with a tidal wave design.” Designs that are rounder, like a wave, are more common in mastectomy tattoos than what artists refer to as masculine designs with defined lines and hard angles. McLain noted most people are looking for something more feminine, “because it suits that part of the body.”
Malamet needed to wait a few years before getting her mastectomy tattoo from McLain. Most artists recommend giving the scarred area at least two years to heal and take shape before covering it. In the meantime, she had a quote from Kurt Vonnegut’s Cat’s Cradle tattooed just below her collar bone. It reads “lucky me, lucky mud”, words from a passage that grapples with the strangeness of being alive and one’s gratitude for it. She’s still adjusting to the permanence, or perhaps the strangeness, of her tattoos but she’s happy when she sees them. “Healing isn’t linear,” she says, referring to her own experience and how she talks about it to others in a similar position. “You’re going to have good and bad days. Some days I wake up and just totally love everything about my body. Other days, I wake up and I’m in mourning over my old breasts.”
Like many people who undergo breast reconstruction, no one can tell what my body has endured, especially when I’m clothed. It’s something for which I’m grateful, as the explanation can be tiring and painful. But, like Malamet and Gallagher, I have not been the same since I made the decision to undergo a preventative double mastectomy. Shortly after scheduling the surgery, I walked into a tattoo shop and asked for a delta symbol, with a gap on one arm, meaning open to change. It was tattooed in the center of my chest, preparing me for what was to come and, now, reminding me to embrace what’s new.