Melissa Kinkade said she probably embarrasses her young sons nearly every day, as they come home from school and she’s practicing and sketching for her medical tattooing business.
“I have two sons. I think one of the quotes was, ‘Mom's drawing nipples again,’” Kinkade said. “First, they laughed when they saw it, and then I explained why it's not funny, like, get all your laughing out. It's not funny. These people have gone through a lot.”
Kinkade is the owner of OneSeven Hair & Permanent Cosmetics, a medical tattooing parlor in Columbia.
She said she has done semi-permanent eyebrow and lip tattoos for years, but during the pandemic she came upon another use for her medical tattooing skills: nipple/areola complex (NAC) tattoos for those who have undergone breast or tissue removal as a part of breast cancer treatment.
“It just always was in the back of my mind of, like, if a tattoo artist can go and put a realistic looking face and eyeball on your arm — you should be able to tattoo a very realistic looking nipple,” Kinkade said. “And I knew there was a need for it, I mean, how many people do you know that have had breast cancer and been affected by that? Everyone knows someone.”
So, over a period of several years, Kinkade practiced and learned. She took multiple courses, both online and in person, and — much to her sons’ chagrin — drew lots and lots of nipples and areolas.
Now, she said she does multiple tattoos a month for clients from all sorts of backgrounds. Some had breast cancer many years ago and have just discovered nipple/areola tattoos as an option, while others have genetic predisposition and have chosen to undergo aggressive breast removal procedures to reduce their chance of developing breast cancer.
According to one 2020 study published in the “Breast Cancer Research and Treatment” journal, the rate of preventative mastectomy has increased three-fold over the last decade due to factors such as increased availability and quality and genetic testing.
Dr. Ashley Wilbers, a breast surgical oncology at University of Missouri Health Care, said she’s also been seeing patients coming in with breast cancer diagnosis as younger ages.
“Doctors have a skill set. I want a surgeon to do my mastectomy, but not my tattoo, and I want my tattoo artist to do my tattoo and not my mastectomy, right?”Nicole Rizzuto, Alliance of Medical Tattooing President
“For young women, where we know their life expectancy is 30, 40, 50, more years, you know, what is the likelihood that they get another breast cancer over the over that course of time?” Dr. Wilbers said. “And so, in general, those women resulted in maybe an increased consideration for doing more aggressive surgery, potentially even as much as a bilateral mastectomy.”
Dr. Wilbers said, overall, the field of surgical oncology has moved toward less invasive surgeries that preserve the original breast tissue, such as lumpectomies where only portions of the breast is removed.
But sometimes that isn’t possible — leaving women looking for interventions that help them reconnect with themselves and their bodies.
“There is a grieving process that does happen,” Dr. Wilbers said. “Women are losing a part of themselves, and person to person, it varies how significant and important that is to their identity. But reconstruction is a place that can step in then and say, ‘Okay, can we at least attempt to help restore that sense of what was lost, right now?’”
But the challenge with nipple/areola tattoos is who should be doing the tattoo in the first place — medical professionals or artists who have specialized skills? And what will insurance cover?
Stacie Becker is a longtime medical tattoo artist in Florida and owns Empower Tattoos. She said it’s important for the two worlds to come together. A good medical tattoo artist needs to be a good artist, but also needs to know the intricacies of working with damaged skin.
“Treatments cause different things to happen to skin," Becker said. "Radiated skin is very different from healthy skin. Certain medications can cause skin to react in different ways."
She said if compromised skin is overworked, it’s possible the skin will stop accepting ink — and, suddenly, an incorrectly or poorly done tattoo could be permanent. Which is why she stresses appropriate training is an important part of being a qualified medical tattoo artist.
“Unfortunately, the training that's available right now for medical tattooing is— it's not really regulated right now in the way that it needs to be,” Becker said.
She is actively working on this issue by partnering with Dr. Jeffrey E. Cassisi, a psychology professor at the University of Central Florida, to conduct foundational research and develop possible curriculum for medical tattoo artists.
Becker is also part of the National Alliance for Medical Tattooing, a national non-profit of artists, advocates and researchers who want to professionalize the specialty.
Nicole Rizzuto is a former certified surgical technologist and a licensed tattoo artist in New York, as well as the founder and president of the organization. She said they want to standardize training, ensure safety and quality guidelines are met and work toward getting insurance to cover nipple/areola tattoos — when done by tattoo artists.
She said it’s not about taking anything away from doctors, but making sure the right expert does the correct work leading to the best possible outcomes for patients.
“Doctors have a skill set,” Rizzuto said. “I want a surgeon to do my mastectomy, but not my tattoo, and I want my tattoo artist to do my tattoo and not my mastectomy, right?”
"There is a grieving process that does happen. Women are losing a part of themselves."Dr. Ashley Wilbers, University of Missouri Health Care
Under the Women's Health Cancer Act of 1998, most health insurers must cover breast reconstruction after mastectomies and other surgeries, which should include nipple/areola complex tattoos.
But Rizzuto said the reality is more convoluted than that — laws and coverage vary state by state. Some require a doctor’s referral for the tattoos or require patients to pay upfront and be reimbursed, while others ask medical tattoo artists to navigate complex medical codes.
In the case of New York, the state legislature passed a law in 2024 that expressly mandates the coverage of nipple/areola complex tattoos, but only “if such tattooing is performed by a physician or other health care practitioner working within their scope of practice.”
“So, legally, in this law, a chiropractor can do the nipple tattoo and can get money back or get it covered, but me, an artist who specializes in this, who understands how to tattoo — can't,” Rizzuto said. “So, a lot more clients, since that law has passed, have been denied because I do provide paperwork for them to submit to get reimbursed for paying out of pocket, but since that law passed, it's becoming a little bit of a problem.”
She said a tattoo done by a medical professional might not be as artistically proficient and could cost thousands of dollars, which insurance may cover.
Whereas the average for a bilateral set of hyper realistic nipple/areola tattoos done by a medical tattoo artist costs between $600 and $800.
Plus, Rizzuto said, working with a tattoo artist should be more collaborative. Artists have dozens of inks at their disposal and can take the time to determine what a client wants their new nipple/areola to look like — down to the level of winkles, folds, or the presence of Montgomery glands, which are small bumps across an areola.
“Even though the tattoo is a very small part of the entire procedure and process of breast reconstruction and mastectomy. They're going to see it every day. They don't see what work they did on the inside with removing all the tissue… but those nipples, that areola, like, that's first and foremost,” Rizzuto said.
Rizzuto said the goal of the Alliance is not to take anything away from the medical team, but instead to give credence to tattoo artists doing nipple/areola tattoos, and to welcome them as a valuable part of a patient’s care team.
“You guys are plastic surgeons, you're breast surgeons — you have enough on your plate. Let us be part of the team, too. We can work together,” Rizzuto said.
