Decorative tattoos after breast cancer surgery

Some people consider having a decorative tattoo on their breast or chest after breast cancer surgery. This is sometimes referred to as a 'mastectomy tattoo', but could be after breast-conserving surgery, a mastectomy or breast reconstruction.

Decorative tattoos are different to nipple and areola tattooing which are usually carried out by a doctor or nurse who has had specialist training.

People consider having a decorative tattoo for a variety of reasons, including to:

• Help them feel more confident after breast cancer treatment
• Mark what they have been through and create something personal
• Cover or disguise a scar

Before getting a tattoo, your operation sites need to be completely healed. This takes around a year, but ideally you should leave it at little longer before getting a tattoo. You should have also finished any chemotherapy or radiotherapy treatment.

Check with your treatment team if you’re considering getting a tattoo.

It’s a good idea to visit a few tattoo studios and watch the artists at work. That way you can see what’s involved, how clean the studio is and get an idea of whether the artist will be able to create something you want. You can also ask to see examples of previous work.

You should find an artist who you feel confident and comfortable with, and who really understands what you would like to achieve. If you know anybody who has a tattoo, ask them where and how it was done and if they are happy with the result.

If you would like a female tattoo artist and would prefer to have the tattoo done in a private room you can ask if these are possible. If you would like to bring someone with you for support, check with your tattoo artist that this would be ok.

Check that the person who is doing the tattoo is registered and has an up-to-date health and safety certificate. Anyone who carries out tattooing should be registered with their local authority. You can contact your local authority to check this.

The cost of a tattoo will vary depending on the artist and the size and design of the tattoo. Some artists charge by the hour. Your chosen tattoo artist should be able to give you an estimate of how much your tattoo will cost.

A tattoo is a permanent mark on the skin made by ink or pigment. Dyes are injected using needles directly under the skin, piercing the skin over and over again until the tattoo is drawn. No local anaesthetic is given and the process can be painful. You may need several sessions to complete the tattoo.

Before having a tattoo, the tattoo artist should ask some health questions. This should include asking about any allergies or any health conditions you might have.

A stencil may be used on your skin before the tattoo is started so you can see the design. Some tattoo artists will send you the design before starting the tattoo to make sure you are happy with your choice.

Most tattoo artists will incorporate any surgical scar into the design and shape of the tattoo, rather than actually inject ink into it. Scars vary from person to person and depend on the type of surgery you have had. This means that some designs will work better than others on different people. Your tattoo artist should be able to advise you on what would work best for you.

They should also make sure you have all the necessary aftercare advice and instructions to care for your tattoo.

For anyone getting a tattoo the biggest risk is from dirty needles that can spread diseases such as HIV and hepatitis. Tattoo artists should always use sterile equipment and fresh needles.

Other risks include:

• Infection – see below
• Allergy to pigment – this is very rare but some studios do offer a patch test before a tattoo
• Changing your mind – it’s possible to get tattoos removed but it’s expensive and can be very painful. There’s also no guarantee that a tattoo can be completely removed.
• The colour (pigment) fading – the pigment will naturally fade over time. To reduce initial fading avoid swimming, sunbathing, using a sunbed or doing exercise that makes you sweat for two weeks after having a tattoo. You can use a high factor sunscreen on your tattoo to help reduce fading

The tattooed area will be swollen, red and may itch but this should go away over time. You may also have some bruising to the area.

If any redness or swelling doesn’t go away and you develop a high temperature or feel feverish you may have an infection. If you think you have an infection contact your GP, nearest urgent care centre or A&E as soon as possible as you may need antibiotics.

An MRI scan uses magnets to get images of inside the body, this can affect any metal or metal fragments in your body.

If you need an MRI tell the radiographer you have a tattoo. This is because some tattoo inks contain traces of metal. However most tattoos are safe in the scanner.

If you do feel any heat or discomfort in your tattoo area while having an MRI tell the radiographer.

It’s currently not known if having a tattoo on your breast or chest increases the risk of developing lymphoedema in that area. Lymphoedema is a build-up of lymph fluid in the surface tissues of the body which causes swelling. It’s caused by damage to the lymphatic system. It’s not clear why some people develop lymphoedema and some don’t but it’s thought infection and further damage to the lymphatic system may play a part.

Some people think about having a tattoo on their arm on the side of their surgery. It is not known if this increases the risk of developing lymphoedema. However, you may be more at risk of developing lymphoedema if you get an infection following your tattoo.

Check with your treatment team if you’re considering getting a tattoo and are concerned about lymphoedema.

Your tattoo artist should give you information about how to look after your tattoo.

You should always wash and dry your hands before touching the area to reduce the risk of infection. Your tattoo may be covered with a non-stick dressing, and you will be told how long to keep this on for.

A tattoo covering a large area may have plastic film wrap applied and you should be told when to replace this. You’ll be advised to keep the area clean and dry. Sometimes the tattoo artist will recommend applying cream to your tattoo. They can suggest which products to use and where you can get them from.

While the tattoo is healing you may not be able to wear a bra, and prefer to wear loose natural fabrics. This may be for around three weeks.

It’s possible to have a tattoo removed using laser technology, but it can take several visits a few weeks apart and can be expensive. There’s also no guarantee that it will be completely removed. It can be painful and cause skin problems, such as becoming red and swollen. The pigment (colour) of the skin can also change.

Sometimes it’s possible to change the tattoo by covering the previous design with another tattoo.

If you would like some inspiration for a tattoo design you can read our blog Eight inspiring mastectomy tattoos. The US charity P-ink.org has a gallery of images that may give you some ideas.

You could also have a look at our online forum and see if anyone has had a tattoo and where they had it done, or start your own thread.