Restorative Tattooing

Discover the transformative power of nipple areola tattooing, microneedling, and scar camouflage after mastectomy.

Introduction to Restorative Tattooing

Welcome to the world of restorative tattooing, something I had no idea about when I was diagnosed, and want to make sure anyone facing a double mastectomy is aware of these beautiful options to consider as part of their reconstruction journey. I am so grateful to have my advisor, Marnie Rustemeyer, a professional restorative and cosmetic tattoo artist, share her expertise and knowledge with you about nipple areola tattooing, micro-needling, and scar camouflage. These procedures can significantly enhance the appearance of reconstructed breasts and scars post-mastectomy. I hope you find this page to be a helpful guide towards the possibilities of your final steps of your reconstruction journey.

– xoxo Cynthia, Founder, Stage 2B 

Nipple Areola Tattooing

Nipple areola tattooing is a procedure that uses tattoo pigment to add natural color to the reconstructed nipple. A specialized, restorative tattoo artist can create a custom pigment to match your skin tone and natural nipple color.

Nipple areola tattooing can be done with or without an underlying nipple reconstruction. Many patients undergo nipple areola reconstruction, using tissue from the newly created breast or less often, from the skin from another part of the body, such as the inner thigh. After the nipple areola reconstruction is fully healed, the area is tattooed to enhance its appearance to create a natural looking breast.

Tattooing can also provide the appearance of a three-dimensional nipple areola on its own. This is a great option for patients who are hesitant to undergo a reconstruction procedure. It is also an excellent approach for patients who are not ideal candidates for nipple reconstruction, like those who have undergone radiation or have thin breast skin.

Nipple areola tattooing is generally painless. It is performed in a medical office and typically involves two visits, one to create a color and begin the process and another to touch up and refine the result. The tattoos should last a lifetime, although in some cases might need further touching up in the future.

People who have undergone breast reconstruction report higher levels of satisfaction after having nipple areola tattoos. Tattooing is often seen as the final touch, completing breast reconstruction by restoring this key element of the breast. These tattoos are also suitable for individuals who have chosen to have an aesthetic flat closure, as they may still benefit emotionally from defining that feature of the chest. Tattooing helps patients to feel restored as they reclaim their bodies post-mastectomy.


Some patients also choose to have artistic tattoos applied to their reconstruction to cover scars and balance asymmetry as a way to further enhance and embrace their bodies and experiences.

In order to be a candidate for nipple areola tattooing, your breast reconstruction must be fully healed, including all nipple reconstruction. A restorative tattoo artist can then assess your skin to ensure that it is safe to tattoo. Some patients with radiated or thin skin or healing incisions may need to wait or undergo a micro needling procedure to minimize scarring in order to be safely and effectively tattooed.


Microneedling is a minimally invasive treatment that rejuvenates the skin. This process creates tiny punctures in the upper layer of the dermis using a device with fine needles, which triggers the body to create new collagen and elastin. Collagen induction therapy, or CIT, is another term for a specific version of this approach. A restorative tattoo artist can perform micro needling using specific needles in a tattoo machine. Micro needling is often a component of restorative tattooing, because it facilitates scar management and camouflage.

Microneedling works by creating a controlled injury to the scar to encourage the body’s natural healing process. Tiny needles activate the scar, which reactivates the body’s natural healing process and stimulates blood flow in the area. The body is often able to heal itself again on a newer, deeper level, creating a softer, lighter scar.

Microneedling is a minimally invasive, in-office procedure. A restorative tattooist will place specific needles in a tattoo machine and run those needles over an existing scar in a controlled and methodical process. The process is typically painless. It may be performed over multiple sessions.

Microneedling can restore blood flow to old scars and enhance healing in more recent scars. It tends to produce lighter, softer, flatter scars, improving their appearance and comfort. It can also prepare an area for scar camouflage tattooing.

Most patients with fully healed incisions are candidates for microneedling. According to a recently published paper in Plastic and Reconstructive Surgery entitled “Microneedling Outcomes in Early Post-Surgical Scars”, some scars may benefit from microneedling during the early maturation period of scar development, at the six-to-seven-week mark of wound healing.

Microneedling candidacy, timing, and techniques must be determined individually, based on the patient. Factors like the type of scar you are looking to improve, your skin type, and the scar’s location influence these decisions. Certain medications can also factor into the overall outcome of any tattooing procedure. It’s important to seek a consultation with a reputable restorative tattoo artist to create a scar management plan.

Scar Camouflage

Scar camouflage is a procedure that disguises scars, making them less distinguishable from surrounding, healthy skin. In some cases, it involves carefully tattooing scars or compromised skin with pigment that matches your skin tone. In other cases, it involves microneedling or collagen induction therapy.

Scar camouflage can be done with or without tattoo ink, depending on your specific scar and skin. In both approaches, a restorative tattooist will apply the same set of fine, rotating needles in the scar. Those needles apply tailored pigment in scar camouflage with tattoo ink. In scar camouflage without ink, those needles are used to stimulate collagen production. Inkless scar camouflage is also known as microneedling or collagen induction therapy (CIT).

All restorative tattooing and scar camouflage are minimally invasive, in-office procedures with minimal recovery and downtime. When a scar is being camouflaged using ink, a restorative tattoo artist will create a custom mix of pigments to match the patient’s skin tone and use a machine to tattoo pigment into the scar. Scar camouflage is not painful. In rare instances, a topical anesthetic can be applied to make the patient more comfortable.

Scar camouflage with pigment works best on scars that are lighter than the surrounding skin. Some patients undergo a combination of microneedling and tattooing with pigment. In those instances, tattooing with pigment follows microneedling or CIT treatments.

All scar camouflage tends to be a multi-step process involving multiple microneedling or tattooing sessions.

Visible scarring can be physically and emotionally uncomfortable. Scar camouflage can mitigate those impacts, helping patients look and feel more well restored.

Most patients are candidates for some type of scar management. Timing and techniques depend on your specific scar and skin type. Certain medications can also factor into the overall outcome of any tattooing procedure. It’s important to seek a consultation with a reputable restorative tattoo artist to create a scar management plan.

Frequently Asked Questions

The most common questions I get about nipple tattooing are does it hurt, what is the recovery time and will it fade.

The tissue we work with has been compromised and two sessions are recommended for the best results. In the first session, I will work with you on determining the size, shape, and color of your new tattoo(s), and the second, I’ll add detail and make any adjustments, including reinforcing areas, that may have faded. The pigments I use are made in the USA and pass strict ESU standards. They are vegan friendly, highly stable, and light fast. They are permanent and, after the final session, should last a lifetime.

I trained under artists and instructors of the highest level. We have a similar fundamental approach in that each client is different, and I create tattoos paying extreme attention to that client’s unique and individual size, coloring, shape, and body type.

Most of our clients say there is no feeling, but some say it can feel like a bee sting or pinching. If there is pain, I can apply a topical anesthetic to make you more comfortable.

On the restorative side, I offer 3D nipple tattooing, scar camouflage, and micro-needling. On the cosmetic side, I offer eyeliner, lips and brows.

There are several great options for patients to find a qualified artist in their area. The Society for Permanent Cosmetics (SPCP) has artists listed by geographical locations on their website. The SPCP artists have a pink ribbon by their name. Clients can also get referrals from their plastic surgeons and social media is a great outlet. Just make sure to research your artists, review their portfolios, and make sure you choose someone whose style you like.

The typical time to wait is 4-6 months after your final surgery; however, there have been situations where a patient may have significant scarring that needs to be treated first and must wait longer. Treating the scars first is essential to the best outcome, and I will provide a scar management protocol prior to the tattooing.

It depends on the client’s insurance. Most private pay companies will cover all, or a portion of, the procedure. For self-pay clients, we will provide a Letter of Medical Necessity for the patient to submit to insurance for potential reimbursement. If a patient doesn’t have insurance, I work with a couple of foundations who will provide grant funding to cover all or part of the services for applicants who qualify.

During the consultation, we will discuss the size, shape, and color of your new tattoos. It’s important to remember that your breast has changed from what it was before and might be discolored as well if you’ve had radiation. If you had a DIEP FLAP reconstruction you may have stretch marks, or even hair, in the areas where the original breasts once were. Some women might have had large areolae before, and now want smaller ones! It’s all about working together to create something beautiful that you will be happy with for years to come.

Restorative tattooing is unique because it helps restore the confidence in not only breast cancer survivors but also people who have discoloration resulting from scars, autoimmune disorders (such as vitiligo), injuries, surgical and other skin conditions.

Restorative tattoo training and certifications address the additional complexities associated with tattooing skin after surgeries.

About the artist

Restorative and Cosmetic Tattoo Artist at NYBRA Plastic Surgery, Advisor For Learn Look Locate

Marnie Rustemeyer is a Board Certified and accredited Permanent Cosmetic Professional (CPCP) and a member of the American Academy of Micropigmentation (AAM). Marnie specializes in creating realistic, 3D nipple tattoos for breast cancer survivors and has helped countless individuals regain their confidence after their journeys with breast cancer.

Marnie believes strongly in patient education, which is why she joined the Learn Look Locate team of experts. Her mission is to provide valuable insights into the end stages of breast reconstruction and recovery, ensuring that individuals have all the information they need for this critical part of their journey.

“Learn Look Locate is a great resource, because it includes information and input from medical and industry professionals who help patients understand what to expect throughout the process. As a restorative tattoo artist, my work comes at the end of the journey. I joined Learn Look Locate’ advisory board to give this community the information they need at the end of their pathway to recovery.”

-Marnie Rustemeyer, CPCP, AAM

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