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The time-saving beauty benefits of [semi-permanent makeup procedures](https://aedit.com/aedition/expert-guide-to-permanent-makeup-cosmetic-tattoo-microblading) (think: microblading and eyeliner) have been widely publicized. Women and men coveting the treatments’ ‘I woke up like this’ promise have propelled the industry into big business. But for many clients, permanent and semi-permanent makeup services go far beyond convenience. In the case of cancer survivors and chemotherapy patients, ‘beauty’ treatments like microblading, permanent eyeliner, lash enhancement, and scar camouflage can be a major step toward regaining self-confidence and a sense of normalcy. Here, we break down everything you need to know with the help of our medical and aesthetic experts.

## **How Semi-Permanent Makeup Helps Cancer Patients**
Cancer treatments (like surgery, chemotherapy, and radiation) can often have an impact on how patients look and feel. Hair loss related to cancer treatments is known as alopecia. It varies from patient to patient and is dependent upon the chemotherapy drugs prescribed and how they react with each person's physiology. “Undergoing chemotherapy, the chances of hair loss are very real and usually rapid for both men and women,” says [Craig Ziering, DO](https://zieringmedical.com/), a board certified dermatologist and hair restoration specialist in West Hollywood. “As the chemotherapy drugs rapidly attack growing cancer cells they also attack other rapidly growing cells in your body — including those in your hair roots.”

Some patients will have patchy hair loss or thinning, while others may lose more — including eyebrows, eyelashes, and armpits. Radiation therapy can also impact the hair, Dr. Ziering says, though usually only in the treatment area. Depending on their needs, patients can choose from both permanent makeup options (with traditional tattoo ink) and the more modern semi-permanent ones (using fruit- and vegetable-based pigments) to restore the appearance of lost hair. These treatments include:

- [Eyebrow microblading](https://aedit.com/aedition/microblading-treatments-for-fuller-thicker-eyebrows)
- Eyeliner and lash enhancement
- [Hairline and scalp micropigmentation](https://aedit.com/procedure/scalp-micropigmentation) 
- Scar camouflage
- [Areola and nipple restoration](https://aedit.com/aedition/reconstructive-nipple-tattoos-for-breast-cancer-survivors-dominique-bossavy)

Permanent makeup expert [Dominique Bossavy](https://www.dominiquebossavy.com/) says that about 20 percent of her clientele is [breast cancer patients](https://aedit.com/aedition/category/breast-cancer-awareness). “They come to me first for eyebrows and lashes in anticipation of losing them to chemo or once they are done with chemotherapy,” she explains. “Usually eyebrows will not regrow or not regrow properly and they may have bald spots. Lashes typically thin out dramatically following chemotherapy. And then there is the need for replacement in trompe l'oeil for the areola.”

But it’s not just for women. Dr. Ziering specializes in hair restoration for men — including men who have lost hair to cancer treatment. He favors a method called scalp micropigmentation (SMP). “SMP is a type of tattooing technique in which microparticles of metabolically inert pigment granules are implanted below the epidermis with a specific, artistic technique of strokes to appear similar to a closely shaved scalp,” he explains. “Over time with SMP, the pigment will fade but the color will not change, so it may give a cancer patient confidence, support, a positive outlook and other positive psychological effects while their hair is growing back.”

## **Permanent Makeup Before & After Chemotherapy**
Timing is important for cancer patients considering permanent and semi-permanent makeup procedures. Because these techniques cause trauma to the skin, they should not be performed on those with compromised immune systems. The general recommendation is to wait six weeks before or after any type of cancer treatment, though it’s absolutely necessary to consult with your oncology team before undergoing any elective or cosmetic procedure.

Both the technique and type of ink or pigment used should play a role in the timing, says permanent makeup expert Yelena Nesterenko. As she explains it, chemotherapy can alter the appearance of the organic, semi-permanent pigments that she prefers to work with — turning browns to blue, black, and even purple. While that’s a big drawback for permanent eyeliner, it’s not as big of a deal for microblading to replace lost eyebrow hair, since it tends to fade more quickly.

While many patients seek treatment (especially for eyebrows) prior to losing their hair, some experts advise a “wait and see” approach. “Methods used to help eyebrow loss may not be necessary in everyone, since not all patients lose brows,” says [Evangelia Kirimis, MD](https://www.uclahealth.org/evangelia-kirimis), a board certified hematologist and medical oncologist at UCLA. “So, I would recommend reserving until after chemo to see what level of help is needed.”

Nesterenko prefers to work with post-treatment patients, though she makes sure all of her clients are prepared for every possible outcome, including additional rounds of treatment. “Your technician should explain everything with details about the color and about the quality,” she says. “Nobody knows how many times the cancer patient will need to undergo chemo.”

If you're concerned about replicating the color and shape of your natural brows exactly, it’s a good idea to meet with your permanent makeup artist for a pre-chemo consultation. If you do end up losing your brows and lashes, photos, sketches, and notes can later serve as a benchmark for your desired results.

## **Permanent Makeup Safety for Cancer Patients and Survivors**
At this point, you’re likely wondering about the safety profile of such treatments. Most experts agree it’s relatively safe, as long as a highly trained technician using quality pigments performs the procedure. Because the body is so sensitive during cancer treatment, any form of tattooing —  which introduces foreign substances into the body through trauma — should be vetted by your cancer care team. The type of pigments and/or ink used, the application technique, and the timing should all be carefully considered.

Many breast cancer patients undergo some form of hormone therapy, since certain types of breast cancer are stimulated by estrogen and/or progesterone. “We know that even low dose birth control pills can affect the pigment,” Nesterenko says. “So, women have to be especially careful about any kind of chemo that affects the hormones.”

Our permanent makeup experts always make sure they have a thorough understanding of their clients’ medical histories and treatment plans. Nesterenko typically works with cancer patients who are referred by doctors she regularly partners with. Bossavy says that many physicians refer patients to her, too, and she requires that clients undergoing treatment receive clearance from their doctor first.

### **Potential Risks and Complications** 
Cancer patients face many of the same risks and complications from permanent makeup as the general population. These risks include:

- Premature/unsightly pigment fade
- Infection
- Allergic reaction
- Scarring
- Granulomas

As mentioned, infection risk may be higher in chemotherapy patients. According to Nesterenko, the effects of chemotherapy on the body often alters the way the skin interacts with both ink and organic pigments, which is why she prefers to work with clients who have finished treatment.

Could tattoo inks and permanent makeup pigments possibly pose an additional cancer risk? Currently, there’s no evidence to suggest it. But Bossavy tells us that, when it comes to the long term consequences of permanent makeup, there’s just not that much scientific evidence out there. “More research is needed to further understand the true implications of these findings and to develop guidelines for the safest tattoo procedures,” she says.

## **How to Find a Permanent Makeup Artist Post-Chemotherapy**
If you are curious about how to find a permanent or semi-permanent makeup artist post-chemo, it’s important to devote the same time and care into researching the technician’s credentials as you would any other provider. Below are five tips for finding the best person for your needs:

1. **Talk to Your Doctor**: Asking your physician(s) for a recommendation is always the best place to start, Nesterenko says.
2. **Consult with Support Groups**: Referrals from other patients can help tremendously when you’re already overwhelmed with treatment-related research.
3. **Ask About Credentials**: It’s important to seek out someone who has worked extensively with cancer patients, not just for cosmetic clients.
4. **Interview Previous Clients**: Ask prospective technicians if you can talk to their other post-cancer clients to learn about their experience and how their results fared over time.
5. **Find Out Inks/Pigments**: “Ink is more stable,” Nesterenko says. “It doesn’t change over time like pigment does, but it’s not safe to use those chemicals on the face.”

Bossavy also tells us that building a rapport is equally critical. “First and foremost is a trust connection. This is a very important part of the process,” she shares. “Many emotions will surface, so I would say [to find] someone that has compassion and someone who loves what they do.” As she explains, it's not uncommon that a cancer survivor will be overwhelmed and moved to tears during the session, which makes finding an artist who is warm, patient, and understanding (in addition to well-qualified, of course!) is all the more important. 

##**The Takeaway**
In the end, the decision to seek permanent or semi-permanent makeup before or after cancer treatment is a very personal one. “Many survivors refer to it as life-changing,” Bossavy says. “It brings back a sense of normalcy and makes them forget the constant reminder of their traumatic and arduous journey of survival during the battle they just had to fight.”

Beauty

For cancer survivors and chemotherapy patients, treatments like microblading, permanent eyeliner, lash enhancement, and scar camouflage can be a major step in the recovery process.

Permanent Makeup For Chemotherapy Patients And Cancer Survivors

The Role Of Permanent Makeup After Chemotherapy

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Nipples, we all have them, and they are entirely unique. Aside from differences in size, shape, and color, protrusion is another characteristic that varies from person to person. For some, it doesn’t happen often, if at all. No, this isn’t an excerpt from a *Sex And The City* episode — it’s a concern women *and* men face. It is estimated that 10 to 20 percent of the female population experiences inverted nipples, and there are many ways to address it. Whether the desire for a more projected look is for aesthetic or functional (think: breastfeeding) reasons, we’re breaking down the treatment options for inverted nipples. 

## **What Are Inverted Nipples?**
Before we get started, it’s important to note that inverted nipples are a benign condition if you’ve always had them. If you experience a sudden nipple inversion, however, it is important to consult with a medical professional, as it could be a symptom of [breast cancer](https://aedit.com/aedition/category/breast-cancer-awareness) or another medical condition. 

Anatomically speaking, the nipple is the part of the areola (the circular ring of pigmented skin around the nipple) that typically protrudes through stimulation or a decrease in temperature. If that doesn’t happen, it may be because the nipple is inverted. “Inverted nipples may be congenital (many patients are born with them) or can be caused by breastfeeding (due to milk duct scarring), trauma, cancer, surgery, or infection,” says [Umbareen Mahmood, MD](https://aedit.com/provider/umbareen-mahmood-md-23), a New York-based board certified plastic and reconstructive surgeon.

To better understand the difference between permanently inverted nipples and those that lay flat on occasion, the technical categorization is as follows: 

- **Grade 1**: “The nipple is either flat or mildly inverted,” Dr. Mahmood explains. “It is easily manually everted, can become everted by touch or temperature, and it maintains its projection.”
- **Grade 2**: “The nipple is manually retractable, but with difficulty, and the nipple tends to retract again immediately,” she says. 
- **Grade 3**: The most severe form, Dr. Mahmood shares that this level of inversion does not allow for manual retraction and “breastfeeding is unlikely.” 

No matter where someone falls on the scale, there are options for those who want a more everted appearance that can be done at home, in a piercing studio, or with the help of a medical professional. 

## **Non-Surgical Solutions for Inverted Nipples**
Depending on your anatomy, you may or may not be aware that there’s a whole world of [nipple protruding techniques](https://aedit.com/aedition/cosmetic-breast-procedures-for-the-nipple-and-areola) and devices on the market. Suction products, massage options, and even piercings claim to help the nipple protrude. 

- **At-Home Exercises**: For those with grade 1 or grade 2 levels, Dr. Mahmood recommends “manual at-home exercises that place pressure at the base of the nipple or suction cup devices that are placed over the nipple and gently stretch the ducts over time.”  
- **Nipple Piercings**: Nipple piercings with barbells are another non-surgical treatment to keep nipples everted for grades 1 and 2, Dr. Mahmood notes. The piercing is not nearly as painful as it sounds and should heal in a few months if proper protocol (wearing a compression garment like a sports bra for the first few days and cleaning regularly) is followed. Another benefit? Many cite an increase in sensitivity to the area after piercing. 

If the at-home methods aren’t working and you aren’t interested in a piercing, surgery may be the best solution. 

## **Surgical Solutions for Inverted Nipples** 
[Inverted nipple repair](https://aedit.com/procedure/inverted-nipples) is a relatively simple surgery performed under local anesthesia that offers permanent results. A small incision is made at the base of the nipple so that “the constricted and tethered ducts [can be] released,” Dr. Mahmood explains. A suture is then placed at the base to support the released nipple. “Pain is very minimal, but there may be some soreness,” she says. Work can be resumed within a few days but patients are “advised to abstain from vigorous exercise for two weeks.” 

Some patients may experience a loss of sensation after surgery, though it is rare. “Nipple sensation is rarely affected after the surgery,” Dr. Mahmood says. Breastfeeding is another consideration. “Nipple stretching techniques for grade 1 and grade 2 do not affect breastfeeding, as milk ducts are left intact,” she explains. “For grade 3, the constricted ducts need to be divided, which will impact breastfeeding.” While diminished milk supply is a potential side effect, “things like pumping as well as medications that stimulate milk production can help women breastfeed,” she adds. 

At the end of the day, women who wish to [breastfeed](https://aedit.com/aedition/how-pregnancy-and-breastfeeding-impact-breast-implants) need to weigh their options. “It depends on how critical breastfeeding is to them,” Dr. Mahmood says. “If they are a grade 3, they may have zero chance at breastfeeding whereas, with the surgery, they may be able to.” 

## **The Takeaway** 
Inverted nipples are often a genetic condition that is not a cause for concern — unless it happens suddenly. In such cases, [breast checks](https://aedit.com/aedition/what-to-do-if-you-find-a-lump-in-your-breast-breast-cancer-awareness) are necessary. While there are non-surgical solutions for those with grade 1 and grade 2 inversion, women who are grade 3 and want a chance to breastfeed may consider an inverted nipple repair surgery. 

Aesthetics

Whether it’s for aesthetics or breastfeeding, there are surgical and non-surgical solutions to treat inverted nipples.

Inverted Nipple Repair Surgery And Body Piercings

Why You Should Stay Abreast Of This Nipple Projection Procedure

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*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to [BCA](https://aedit.com/aedition/category/breast-cancer-awareness), from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back.*

It's October, which means it's time to think pink. If you are looking for a way to shop for good, brands are giving back all month long in honor of Breast Cancer Awareness Month. From serums and fragrances to face masks and hair ties, there are plenty of ways to shop for the cause. Keep scrolling to shop our favorite beauty, fashion, and lifestyle Breast Cancer Awareness finds below!

### **Ralph Lauren Romance Pink Pony Edition**
![AEDIT-Ralph-Lauren](//images.ctfassets.net/zw35sfestf1t/2kJ8IerXgdDKn5pDX0ye3s/be03ae83149ac1e8607e5d0aff9fb0b3/AEDIT-Ralph-Lauren.png)
Ralph Lauren Fragrances is celebrating the 20th anniversary of the [Pink Pony Fund](https://www.ralphlauren.com/brands-polo-ralph-lauren-women-pink-pony-feat) with an exclusive new addition to its bestselling Romance franchise. The warm citrus scent prominently (and aptly!) features pink peony, alongside bergamot, ginger, rose centifolia, and sandalwood, and 100 percent of the profits benefit the non-profit. $98, [macys.com](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fwww.macys.com%2Fshop%2Fproduct%2Fralph-lauren-romance-eau-de-parfum-pink-pony-edition-3.4-oz.%3FID%3D11419217)

### **MASKnSIP Limited Edition Hot Pink Mask**
![AEDIT-MasknSip](//images.ctfassets.net/zw35sfestf1t/6iTrCtpszoo6l4zBRjXIgg/d3f34296720c215d22a851c9240806b4/AEDIT-MasknSip.png)
Developed by celebrity dentist Jennifer Jablow, DDS, and fashion stylist Christina Wilson, MASKnSip is the first antimicrobial face covering designed for drinking — thanks to a resealable flap and straw hole. Ten percent of profits from this pink edition benefit [Young Survival Coalition](https://www.youngsurvival.org/), an organization dedicated to supporting young breast cancer survivors. $23, [buymasknsip.com](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fwww.buymasknsip.com%2Fproducts%2Fhot-pink-mask)

### **Estée Lauder Advanced Night Repair**
![AEDIT-Estee-Lauder](//images.ctfassets.net/zw35sfestf1t/68LOC8ZzGox4ytM5ZvTtjl/e00bc80122fc34936a131c4c69df875b/AEDIT-Estee-Lauder.png)
The brand’s best selling night serum is all dressed up in hot pink packaging for a good cause. For each purchase, Estée Lauder will make a donation of 20 percent of the suggested retail price to the [Breast Cancer Research Foundation](https://www.bcrf.org/). $105, [bloomingdales.com](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fwww.bloomingdales.com%2Fshop%2Fproduct%2Festee-lauder-limited-edition-pink-bracelet-advanced-night-repair-1.7-oz.%3FID%3D3798309)

### **Cosabella Never Say Never Curvy Racie Racerback Bra**
![AEDIT-Cosabella](//images.ctfassets.net/zw35sfestf1t/3twpTVolEhvNie0GALsowQ/5e4d3adf6c6d3bbbfdfc548e5ae4f609/AEDIT-Cosabella.png)
The lingerie brand is supporting [Susan G. Komen](https://ww5.komen.org/) with its Never Say Never collection. In October, five percent of the retail sales price of this animal-print bralette are donated to the organization. $75.50, [cosabella.com](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fwww.cosabella.com%2Fproducts%2Fnever-say-never-printed-curvy-racie-bralette-victorian-pink-animal-en)

### **Isola Rose + Vanilla Cream Body Oil**
![AEDIT-Isola](//images.ctfassets.net/zw35sfestf1t/5LPExlbzQ6q3u9vTFEnRXP/7c5b55dd403c2b3942456e38bde04802/AEDIT-Isola.png)
All October long, 30 percent of proceeds from this 100 percent vegan body oil benefit [Breast Cancer Prevention Partners](https://www.bcpp.org/). The hydrating blend of coconut and sweet almond oils smells softly of rose and vanilla, which means the nourishing oil doubles as an all-natural perfume. $34, [isolabody.com](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fisolabody.com%2Fcollections%2Fperfume-body-oils%2Fproducts%2Frose-vanilla-cream-perfume-body-oil-1)

### **Teleties Nature’s Palette**
![AEDIT-Teleties](//images.ctfassets.net/zw35sfestf1t/5t5U0UnyaPvDIuyCWyO8IN/236fe7fd8536082770c7b7cda95acccf/AEDIT-Teleties.png)
If you’re in search of durable hair ties that won’t damage your mane *and* look cute on your wrist, these coiled bands are it. With each purchase, the brand donates to [FORCE](https://www.facingourrisk.org/index.php), a non-profit that seeks to improve the lives of those affected by hereditary breast, ovarian, and related cancers. This particular pack features three small and two large. $15 for five, [teleties.com](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fwww.teleties.com%2Fproducts%2Fnatures-palette)

### **Athena Club All Day Deo in Scent No. 2**
![AEDIT-Athena-Club](//images.ctfassets.net/zw35sfestf1t/GjkazSa6HPoYrYhFj3GNN/679d205976929d38e1497b3ce04d97ea/AEDIT-Athena-Club.png)
This month, 50 percent of the proceeds from this aluminum- and cruelty-free deodorant benefit [Bright Pink](https://brightpink.org/), a non-profit that empowers young women to proactively manage their health and know breast and ovarian cancer risks through preventative care. The stick formula smells of rose, sage, and cedarwood and leaves no white residue behind. $11, [athenaclub.com](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fwww.athenaclub.com%2Fproducts%2Fall-day-deo)

### **Natalie Mills Stella Sequin Face Mask**
![AEDIT-Natalie-Mills](//images.ctfassets.net/zw35sfestf1t/37BahUlJ2P5dueK0CpDp6L/7f5e15588b031a72d46aacf22787f0e1/AEDIT-Natalie-Mills.png)
Up your mask game with this reusable sequin-spangled design. Made of three-layer cotton, 30 percent of sales from the face covering are donated to [The Pink Fund](https://www.pinkfund.org/) in October. $19.50, [nataliemills.com](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fnataliemills.com%2Fcollections%2Ffacefashion%2Fproducts%2Fdusty-pink-face-mask) 

### **The Better Skin Co. For All Glow Primer & Beauty Oil**
![AEDIT-Better-Skin-Co](//images.ctfassets.net/zw35sfestf1t/5aWU83MA3HpmgLUepYOmiS/fc32e21a7658e7dc6b8e12931d75f02b/AEDIT-Better-Skin-Co.png)
This October, 100 percent of proceeds from the sale of this new antioxidant-packed primer-oil hybrid benefit [Hello Gorgeous](https://www.hellogorgeous.org/about-us), a non-profit that provides complimentary makeovers and cosmetic education to women battling cancer. $28, [thebetterskinco.com](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fthebetterskinco.com%2Fproducts%2Ffor-all-glow) 

### **Kendra Scott Elaina Friendship Bracelet**
![AEDIT-Kendra-Scott](//images.ctfassets.net/zw35sfestf1t/46Si87hw1GlI88rn9IBvL0/cb31a93d761bae71f8e0ad13b2cb7968/AEDIT-Kendra-Scott.png)
In October, 20 percent of the sales from this rose quartz bracelet support the [Breast Cancer Research Foundation](https://www.bcrf.org/) through the funding of the jewelry designer's third grant, the Kendra Scott Award in Honor of Holley Rothell Kitchen. $48, [kendrascott.com](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fwww.kendrascott.com%2Fwe-give-back%2Flearn-more%2Fshop-for-good-breast-cancer-awareness%2F842177100554.html%3Fcgid%3Dshop-for-good-breast-cancer%23start%3D2)

### **Laura Geller Pink Lambswool Paddle Blending Tool**
![AEDIT-Laura-Geller](//images.ctfassets.net/zw35sfestf1t/2MyDSL5QcOIjrRuur9wMay/19217be8a65ca17135e4f61f2c3f93b8/AEDIT-Laura-Gellar.png)
Inspired by her own breast cancer diagnosis, the makeup artist is donating a portion of all proceeds from her collection (with a minimum contribution of $15,000) to the [Dubin Breast Center at Mount Sinai](https://www.mountsinai.org/locations/dubin-breast-center) for treatment, prevention, and research. If you’re wondering what to treat yourself to, look no further than this limited edition pink lambswool paddle that is designed to give makeup an airbrush finish. $25, [lauragellar.com](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fwww.laurageller.com%2Fproducts%2Flambswool-paddle-blending-tool-special-edition) 

### **POWERHANDZ Power To Fight Gloves**
![AEDIT-Powerhandz](//images.ctfassets.net/zw35sfestf1t/16AUIMekdinaPYXwowDBKA/76025c347035a8028ac2f503902539e2/AEDIT-Powerhandz.png)
These weighted, fingerless gloves designed to strengthen hand and arm muscles and increase hand speed, providing the perfect boost to any workout routine. A portion of the proceeds from this special pink edition of the gloves are donated to a breast cancer charity via the [Power to Give Foundation](https://powerhandz.com/power-to-give-2/), the brand’s non-profit entity. $55, [powerhandz.com](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fshop.powerhandz.com%2Fproducts%2Fpower-to-fight-gloves)

### **Journelle Estelle Hipster in Blush**
![AEDIT-Journelle](//images.ctfassets.net/zw35sfestf1t/3GyLRbr9LNWJ8eyOyV5Ddg/633af2faf91335c04897231b7f89dd25/AEDIT-Journelle.png)
Upgrade your lingerie drawer for a good cause with this cheeky blush pink style. All month long, 15 percent of the retail sales will benefit [Susan G. Komen](https://ww5.komen.org/) breast cancer research. $22, [journelle.com](https://go.skimresources.com?id=170670X1638612&xs=1&url=https%3A%2F%2Fwww.journelle.com%2Fproducts%2Fjournelle-estelle-hipster-105672%3Fcolor%3D331)

Now Trending

From makeup and skincare to face masks and jewelry, these are the products that allow you to look good and do good all October long.

Breast Cancer Awareness Month 2020: Beauty And Fashion Products That Give Back

13 Products That Give Back For Breast Cancer Awareness Month

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*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to [BCA](https://aedit.com/aedition/category/breast-cancer-awareness), from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back.*

For women affected by breast cancer or those with the BRCA gene mutation who are proactive, post-mastectomy life used to be either an implant or no-breast kind of existence. There is, however, a promising new reconstructive procedure offering [mastectomy patients](https://aedit.com/aedition/what-to-expect-before-during-after-mastectomy-breast-cancer) a third option. It’s called SWIM Breast Reconstruction, and we spoke to the woman who is pioneering the technique, Beverly Hills-based board certified plastic and reconstructive surgeon [Lisa Cassileth, MD](https://www.drcassileth.com/surgeons/dr-lisa-cassileth.html), to learn more about the method.

## **History of SWIM Breast Reconstruction** 
First and foremost, you may be wondering what ‘SWIM’ means. SWIM stands for skin-sparing wise-pattern internal mammary perforator. The procedure, which Dr. Cassileth says “spares the skin you need and spares the mastectomy appearance,” combines a nipple-sparing mastectomy with a breast reduction. Blood flow to the nipple is preserved, all breast mammary tissue is removed, and the leftover skin and fat from the original breast and surrounding area is folded to create a new breast.

The idea for this procedure was born when Dr. Cassileth and mastectomy surgeon [Heather Richardson, MD](https://www.bedfordbreastcenter.com/mastectomy-surgeon-heather-richardson-md/), of the Bedford Breast Center in Beverly Hills, were talking about the limited options patients are offered. The fact of the matter is, all too often, the [plastic surgeon isn’t in the room](https://aedit.com/aedition/post-mastectomy-breast-reconstruction-process-breast-cancer) for reconstruction conversations before or during a mastectomy procedure. Getting rid of the cancer is, understandably, the only goal. As a result, many patients simply leave with a scar. 

When the two surgeons finally worked on the same patient, it wasn’t an ideal situation. There was a radiated breast on one side and new cancer on the other. The patient — Dr. Cassileth’s coordinator’s mother in law — needed a bilateral mastectomy, and the doctors wanted to do the best thing they could for her. The duo created the idea of the SWIM reconstruction procedure, performed it together, and were pleased with the results. 

Within weeks, they had a similar patient. “We developed this procedure over time for these needy patients with nowhere to go and no options for them,” she explains. Previously, many women who had total mastectomies end up wearing a bra with a ‘chicken cutlet’ insert or a padded bra to match the other breast. But, when they raise their arms, the bra can “stick” in their mastectomy divot, Dr. Cassileth says. This is a common experience for thousands of women. As time went on, another segment of the population also embraced the SWIM technique — a younger demographic who wanted to avoid implants.

## **How SWIM Breast Reconstruction Works**
Before this procedure, Dr. Cassileth says her practice encountered women who simply didn’t want implants or aren’t a good candidate for them. The way the SWIM procedure works is that, after a mastectomy, the skin and fat surrounding the breast are meticulously folded and reshaped to create a new breast, while preserving the existing nipple. The breast reconstruction takes place during a one-stage surgery and adds a couple hours to the mastectomy.

First, the mammary tissue is removed during the mastectomy portion of the procedure, while the skin and subcutaneous fat are preserved. During the reconstruction portion of the surgery, the extra fat is folded and placed to create the breast shape. Unlike traditional flap surgeries, no muscle is sacrificed and no abdominal, back, or buttocks tissue is transferred. This provides an alternative for women who want to avoid the extensive surgery, incisions, and long recovery period involved with a [TRAM and DIEP flap procedures](https://aedit.com/aedition/comprehensive-guide-to-breast-reconstruction-nipple-reconstruction-after-breast-cancer). 

There are no long-term negatives or additional surgeries with the SWIM breast reconstruction, Dr. Cassileth says. But there are some finer details to understand. Below, she answers some common questions about the procedure:

### **1. Who Is A Good Candidate for SWIM Breast Reconstruction?** 
Women with breasts that are a B cup or larger are good candidates for this procedure. “Any configuration of a female bigger than a B, you’ve definitely got extra skin,” she explains. You take the breast tissue out of the breast, and you still have all the skin. “You use the extra and fold it up to make this cute breast ... and there’s no maintenance on it,” she says.

Proactive patients, such as those with the BRCA gene mutation, have been opting for the SWIM procedure because they often have a bit more time to consider their options. “The more time people have to research, the more likely they are to find this surgery,” Dr. Cassileth says. These women represent about 50 percent of Dr. Cassileth’s patients for this procedure. “Many women don’t want implants because the implant is foreign body,” she explains. “Plus, they don’t want surgery every 15 years to redo it.”

### **2. Who Isn’t A Candidate For SWIM Breast Reconstruction?** 
If someone is an A cup or smaller, they’re not a good candidate. “They need leftover skin to make a breast out of,” Dr. Cassileth explains. 

### **3. Is there more risk of cancer returning with SWIM reconstruction?**
No, the mammary tissue is completely removed with the SWIM flap procedure, Dr. Cassileth says. “It follows a complete, total, skin-sparing mastectomy — the same mastectomy as is done with a typical reconstruction,” she adds. It’s important to note, however, that no mastectomy has zero recurrence risk. Recurrence is one to three percent for every mastectomy, regardless of the reconstruction technique. 

### **4. Can the new breast(s) be customized?**
“The hard thing to counsel on is gauging how big people will be, and they do ask,” Dr. Cassileth says. It’s a guess, as she must see what’s left over from the skin and subcutaneous fat after the mastectomy. “You could have very heavy breasts but a small amount of subcutaneous fat,” she explains. You can also have little breasts with a lot of subcutaneous fat. Dr. Cassileth can estimate from there and use whatever her patients “give her.” “I’ll keep whatever I can,” she says. 

While a patient typically won’t go from a D cup to an A, sometimes people say they want to be at least a C. In this case, patients can return for an additional procedure, like [fat grafting](https://aedit.com/aedition/why-everyone-is-talking-about-fat-grafting), down the line. “That is an additional procedure and is all natural, all you,” Dr. Cassileth explains. “But you have to build the foundation and go from there.”

### **5. What Is SWIM Breast Reconstruction Recovery Like?** 
Dr. Cassileth says it’s similar to mastectomy reconstruction and takes about a month. You have a week of being sore and a second week of being functional, but you can’t jog or lift anything heavy. “I won’t let someone do super heavy weights until the fourth week,” she says, but, by the third week, you’re pretty much back to your regular routine. This recovery is two weeks shorter than direct-to-implant reconstruction, which is a procedure she still performs regularly. 

## **The Takeaway**
Earlier this year, Dr. Cassileth and Dr. Richardson had an [article published](https://www.journalacs.org/article/S1072-75152030076-4/fulltext) in the *Journal of the American College of Surgeons* about the procedure, and the pair have been training fellow surgeons in the technique. The hope is that, long term, SWIM breast reconstruction will catch on and become a safe, effective, and common breast reconstruction option for women around the world. 

For women diagnosed with breast cancer or those with the BRCA gene mutation who are proactive, post-mastectomy life used to be either an implant or no-breast kind of existence — until now.

SWIM Breast Reconstruction: A No-Implant Technique For Breast Cancer Mastectomy Patients

SWIM Breast Reconstruction: A New No-Implant Technique For Mastectomy Patients

shutterstock 1407724754 (1)

*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to [BCA](https://aedit.com/aedition/category/breast-cancer-awareness), from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back.* 

Because breast cancer awareness has become so mainstream in recent years with everyone from celebrities to the NFL dedicating time and resources to supporting the cause, men and women alike are increasingly aware of the warning signs. Women especially are encouraged to regularly conduct their own self-breast exams and may even ask their partners to let them know if they notice any changes, too. 

But what happens if/when you find a lump? Because breast cancer has such a high profile and statistics like *one in eight women will be diagnosed in their lifetime* are well known, people are often fearful to seek medical advice after noticing a change in their breast tissue because they assume the worst. 

While it is absolutely essential to get any changes checked out by a medical professional, it is also important to remember that 80 to 85 percent of lumps found in women under the age 40 are benign and caused by fibrocystic changes, cysts, fibroadenomas, or fat necrosis to name a few.

With this in mind, it is important to understand the function and importance of breast exams. We’ve already shared the resilient stories of mastectomy patients ([HERE](https://aedit.com/aedition/mastectomy-breast-cancer-experience-from-patient-perspective)) and those who have undergone breast reconstruction procedures ([HERE](https://aedit.com/aedition/post-mastectomy-breast-reconstruction-process-breast-cancer)), and in this article, The AEDITION speaks to women who found a lump and decided to do something about it.

## __Breast Check Basics__
For women with no family history of breast cancer, [the American College of Obstetricians and Gynecologists advises](https://www.acog.org/patient-resources/faqs/gynecologic-problems/mammography-and-other-screening-tests-for-breast-problems) people in their twenties and thirties have a breast examination carried out by a healthcare provider every one or three years. The American Cancer Society, meanwhile, [recommends annual mammograms](https://www.cancer.org/healthy/find-cancer-early/cancer-screening-guidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html) for women between the ages of 40 and 55. Women over 55 can switch to mammograms every two years or continue with yearly screenings. But that doesn’t mean you should just sit around for your next trip to the gynecologist. 

Women are encouraged to conduct a self-examination about once a month. Because benign lumps are known to appear over the course of a woman’s menstrual cycle, it is best to perform the exam at the same time every month — ideally a few days after your period ends.

During the exam, it is important to be on the lookout for any changes in the appearance of both the exterior breast (skin, areola, and nipple) *and* the interior tissue. Things to feel and look for include:

- A visible change in the shape or size of the breast or nipple
- A change in how the breast skin looks or feels (think: dimpling or puckering) 
- Soreness, redness, or rashes on the breast or underarm area
- Any areas that are visibly different compared to the rest of your breast tissue
- A lump (can be a small as the size of a pea) that persists in the breast or underarm area

If you notice any of these symptoms or something just doesn’t feel like your version of ‘normal,’ it is time to consult a medical professional for a more thorough check. Chances are, it is simple to treat. But if it is breast cancer, early detection is key.

## __Patient Perspective__ 
There are no two ways about it: finding a lump in your breast or noticing some other change to the chest can be alarming. But that is not an excuse for inaction. Here, The AEDITION speaks to three women who lived through a breast cancer scare about their experiences and why they encourage everyone to consult a doctor as soon as they notice something isn’t quite right.

### __Anna, 29, Los Angeles__ 

<Dialogue>
  <Question party={The AEDITION}>
    What caused you to become concerned about your breasts?
  </Question>
  <Response party={Anna}>
    I was at college and aware that I needed to check myself every so often. I didn’t check as often as I now know I should, but one day I was in the bathroom and found a lump. It was probably around the size of an olive. I panicked and decided I wouldn’t tell anyone. My theory was that if I ignored it, it would go away. I would prove to myself that it wasn’t anything serious. But after a while, it was still there. A family friend had been diagnosed with cancer recently, so I guess it was on my mind. I made an appointment to see my doctor. At that point, I was convinced the only thing it could be was cancer.
  </Response>
  <Question party={The AEDITION}>
    What happened during your doctor’s appointment?
  </Question>
  <Response party={Anna}>
    I explained to the physician that I found this lump and that I thought I might have breast cancer. I was so anxious, but the doctor took the time to listen to me while I gave my garbled version of events. She then checked the lump herself, which was uncomfortable, but it didn’t take too long. She then asked me whether I had any pain, whether it changed during my cycle, and whether or not I’d noticed any other symptoms. I was referred for an ultrasound — my doctor explained it would give her a clearer idea of what was going on — but she also took some time to reassure me that it could very easily be something simple to treat and not cancer at all.
  </Response>
  <Question party={The AEDITION}>
    What did the next steps look like for you?
  </Question>
  <Response party={Anna}>
    First of all, I told a friend, which was probably the best thing I did throughout the process. She was able to reassure me and she also came with me to my other appointments. I had the ultrasound quite soon after the first appointment. Again, it was uncomfortable in that I’m not keen on being naked in front of random people, but, other than that, it wasn’t painful or anything. About a week after that I went back to the primary care doctor, who explained to me that it was a cyst. Because it was filled with liquid and not solid, I didn’t even need to have a biopsy. She told me to keep an eye on it, and if it became painful, they could offer me some other treatment options. That was about four years ago now, and I haven’t had any problems since. I do check my breasts regularly though, and I’m such an advocate for people getting any concerns checked out quickly.
  </Response>
  <Question party={The AEDITION}>
    What advice do you have for someone who finds themselves in a similar situation?
  </Question>
  <Response party={Anna}>
    I would say do the brave, grown-up thing and get it checked. Don’t bury your head in the sand because, if it is cancer, that’s literally the worst thing you could do. I think the awareness we have of breast cancer is amazing now, but it can make finding an issue so scary because the first thing that comes to mind is cancer. I also think people should share their concerns. Chances are a friend has been through a very similar thing — especially by the time you reach your late twenties. I know so many people who have been through the same panic. It’s best to share with both friends and doctors.
  </Response>
</Dialogue>

### __Stephanie, 58, Texas__

<Dialogue>
  <Question party={The AEDITION}>
    What led you to believe you might have breast cancer?
  </Question>
  <Response party={Stephanie}>
    I was checking my breast, which I do regularly now that I’m older. I felt something a bit different on my right side — almost in my underarm area. I had a sinking feeling when I first felt it and managed to calm myself down enough to have a Google, which, in hindsight, was not my best idea. I was pretty sure what I found could be a sign of breast cancer, and, honestly, I was scared. It took me a few days to gather together the courage to get a consult, but I didn’t want to leave it because I know how important it can be to get a diagnosis as soon as possible.
  </Response>
  <Question party={The AEDITION}>
    What pushed you to visit a doctor?
  </Question>
  <Response party={Stephanie}>
    I think breast cancer awareness has reached this amazing level where most of us know to check ourselves and not to mess around with it if we do find something a bit suspicious. I gave myself a couple of days to accept the potential reality of the situation and went to see my doctor. I explained the situation, and he took a look. Fortunately, the office also has an ultrasound room and I was able to sit and wait for it to come available there and then. I was told I had a liquid-filled cyst, and I was booked in for a biopsy. A couple of days after the biopsy, I received a call from my doctor, who explained what it was. He told me that I had an oil cyst, which can happen when fat is damaged. It wasn’t cancer at all. He praised me for being so reactive when I found it and told me to go and get on with my life — but to keep on checking in the future.
  </Response>
  <Question party={The AEDITION}>
    Did you know about fat necrosis when you initially felt the scar tissue in your breast?
  </Question>
  <Response party={Stephanie}>
    I honestly thought I was well informed about all things breasts, but apparently I was not. I hadn’t ever heard of it. I think it’s really important that, as much as we now all learn about checking for cancer, we also get told about other, far less life-altering issues we could develop in that area. I think it can be reassuring — especially for younger people — to know there are other conditions out there. Finding out quickly can save a lot of stress, but it is also important if it is cancer.
  </Response>
</Dialogue>

### __Jennifer, 34, Miami__

<Dialogue>
  <Question party={The AEDITION}>
    Could you give us an idea of the symptoms that led to your concern?
  </Question>
  <Response party={Jennifer}>
    It happened not long before I stopped breastfeeding my daughter, so I was kind of acutely aware of what was going on with my breasts. One of them started to get a little painful and, over time, got somewhat swollen and warm. My main concern was getting it seen quickly. Not only was I in pain, but I was scared that if I left it, I could jeopardize my future with my daughter.
  </Response>
  <Question party={The AEDITION}>
    What was your experience like with your doctor?
  </Question>
  <Response party={Jennifer}>
    I went to see my daughter’s pediatrician for an appointment that had been booked for weeks. While I was there, I broke down in tears and explained what was going on. The doctor was so lovely. She told me it sounded like an infection called mastitis, which is super common for new moms. She explained to me that I just needed some antibiotics and to keep an eye on how it progressed. She was so sweet and completely understood why I was so worried about the situation. Since then, I’ve done a fair bit of research just out of curiosity, and it turns out there are so many breast conditions I had no idea even existed. I think it’s so amazing that cancer awareness pushes people to check themselves and to consult quickly. I’m certain it’s helping to save hundreds of lives every year.
  </Response>
  <Question party={The AEDITION}>
    What advice would you give to someone who is feeling worried about consulting a doctor about a concern they have with their breasts?
  </Question>
  <Response party={Jennifer}>
    I think the concern stems more from the fear of it possibly being something ‘big’ as opposed to the fear of consulting in itself. And I do think that people knowing there are other things the symptoms could point to — aside from cancer — is reassuring on that front. That being said, I think the urgency that has been created from awareness is crucial when it actually is cancer. I think, if you’re concerned, ask for help as soon as possible, but hold on to the fact that 85 percent of lumps and bumps that people consult about are not cancer at all.
  </Response>
</Dialogue>

Patient Perspective

There are no two ways about it: noticing a change to your breast can be scary. But that is not an excuse for inaction. Here, The AEDITION speaks to three women who experienced a breast cancer scare and did something about it. 

What To Do If You Find A Lump In Your Breast

shutterstock 383018863 (1)

*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to [BCA](https://aedit.com/aedition/category/breast-cancer-awareness), from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back.*

It is estimated that some 250,000 women in the U.S. will be diagnosed with breast cancer each year. More than half of these cases will require invasive treatment like mastectomy procedures. 

For many, surgical breast reconstruction is an important part of the treatment and recovery process (read our comprehensive guide to breast reconstruction [HERE](https://aedit.com/aedition/comprehensive-guide-to-breast-reconstruction-nipple-reconstruction-after-breast-cancer)). Just as advancements have been made to mastectomy techniques, similar progress has occurred in reconstruction. Life-like, three-dimensional tattoos now offer patients a non-surgical alternative to traditional areola and nipple restoration. These medical tattoo techniques allow patients to achieve natural-looking breasts after surgery, as well as treatment for conditions like burn disfigurement, scarring, and skin discoloration. 

## __What Are Medical Tattoos?__

Medical tattooing, also known as medical [micropigmentation](https://aedit.com/procedure/scalp-micropigmentation), is a technique that is used as part of restorative and reconstructive medicine to help patients regain the natural appearance of their post-surgical and post-trauma skin with tattoos. The method, which involves sterile pigments being injected into the top layers of the skin using a medical tattoo machine, can be used to treat a wide variety of cosmetic concerns that have resulted from injury or illness.

One of the most life-changing applications of the method is for areola and nipple reconstruction in patients who have had a mastectomy. The procedure, when carried out by an experienced practitioner, allows patients to have natural-looking breasts once again — without additional surgery. 

## __What Options Are Available for Nipple and Areola Reconstruction?__

The main decisions patients face when it comes to nipple and areola reconstruction is whether they wish to undergo an additional surgery, opt for a non-surgical approach, or settle on a combination of the two. 

In terms of surgical options, patients can have a nipple created using a flap of skin on the breast that is reshaped to mimic the natural protrusion of the area. A skin graft, meanwhile, is employed to recreate the areola. These procedures are typically classified as outpatient and performed under local or general anesthesia after the initial reconstructive surgery scars have healed. Patients can also have the skin flap nipple reconstruction without the areola restoration. In this case, the areola is tattooed when the wound has healed.

For patients who do not wish to have further surgery, they may choose to commission a personalized silicone prosthesis or opt for reconstructive tattoos. Not your average ink, the tattoos must be carried out by a highly skilled and specialized practitioner, who understands the anatomy of the area, in addition to having a deep understanding of the emotional impact of the process.

## __Ask the Expert__

[Dominique Bossavy](https://www.dominiquebossavy.com/) is a pioneer of the reconstructive tattoo field. Born and raised in France, she trained in Paris before establishing her practice in the U.S. Using her proprietary NanoColor Infusion technique, she works with clients in both New York and L.A., offering both medical and cosmetic tattoo services — including scar treatment, eyebrow microblading, and French lip blushing to name a few.

She works clients following surgery or trauma to help them feel like themselves again by improving the appearance of scars and other skin concerns, and her areola restoration has become an important part of the breast reconstruction process for post-mastectomy patients. Here, she tells The AEDITION about her technique and the life-changing impact her work has on cancer survivors.

__The AEDITION:__ *How did you start your career in semi-permanent cosmetics? How did that journey result in you honing the NanoColor technique you use today?*

__Dominique Bossavy:__ At first, I was a client who was interested in the services of semi-permanent cosmetics. Unfortunately, I ended up with a botched job on my lips, which looked like I had a dark, unsightly line outlining my lips. It was upsetting and disfiguring. I was looking to find something to enhance my lips and thought that the product and process were possible, but the execution was just not there. I knew that needed to be a way to use this process and this technology, so it was really my search to find someone to help me fix the unsightly black line around my lips that I found my mentor and my calling. I was in France and found someone who was, at the time, a leader in the field and she offered me an internship to learn the art of her trade and techniques. 

Although I loved the concept and was fascinated by it, I still hated the results, which were still too obvious and unnatural. Even training with the best in the field at that time, I felt the industry was unsuccessful at truly enhancing the real essence of a woman’s beauty. So, I was faced with the challenge to either find a different way or to quit the industry.

I took on the challenge and began to dissect the entire process — from the application process to the molecular breakdown of colors — and figure out why it looked so flat or why the colors always looked unnatural or eventually faded to unnatural colors. I wanted to find the best solution to enhance features — with undetectable definition, dimension, and dynamic — to highlight natural beauty. I researched every aspect of the procedure in-depth and collected valuable facts before creating my specific NanoColor Infusion techniques.

__The AEDITION:__ *What concerns are you able to address for patients using your NanoColor Infusion technology and tattooing technique?*

__DB:__ I have worked on solutions to several problems women face, including burn disfigurements, post-trauma and post-surgery scars, stretch marks, hypo- and hyper-pigmentation, vitiligo, and alopecia. I even recreated a trompe l'oeil version of a missing toe and toenail and have tattooed the cornea of a blind eye. When people come to me with a problem, I always do my best to be the solution — even if it has never been done before.

__The AEDITION:__ *How does the nipple and areola restoration work?* 

__DB:__ I use non-allergenic microparticles of custom-blended colors that are skillfully infused into the dermal layer of skin to simulate natural-looking or well-defined makeup. 

In cases of reconstructive breast surgery after mastectomy, the medical micropigmentation process is used to improve the aesthetic appearance of the nipple-areola complex. The application of flesh-colored pigments to the restored areas of the areola may be utilized either as a supplement to or as a less invasive alternative to the skin-grafting procedure that, for many years, was the only available method of restoring balanced coloration to the area. 

Scar removal or camouflage is key, as is the realistic appearance of the areola pigmentation with its nuances. No one has only one color or texture in their breast tissue, and there are veins, hair follicles, and other details that make each client unique too. 

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/1x1Cvi2ILWXeH4VIjUA6CW/00397e001b465fd5e2337edbf2a3276e/Screen_Shot_2019-10-17_at_11.53.45_AM.png}>
  A before-and-after of Bossavy's trompe l'oeil 3D areola for a breast reconstruction patient.
</CaptionImg>

__The AEDITION:__ *What does the consultation and tattooing process entail?*

__DB:__ Usually, the process takes several visits to obtain the desired final result. First, I take measurements, assess the asymmetries, and draw the areola onto the woman's breast. Then, I pick the three colors necessary to create a three-dimensional effect. A topical anesthetic is then applied to the client's breast and, within 45 minutes to an hour, the work is complete. It takes about nine days to heal. A second session is scheduled at six weeks to perfect the work and sometimes a third appointment is needed for some additional layering of color or texture. 

__The AEDITION:__ *How realistic are the results?*

__DB:__ Areola pigmentation has come a long way. It is no longer a bullseye tattoo over the breast mound. I actually create a 3D nipple which gives the illusion of protrusion that makes the tattooed areola very realistic with some depth and details of color and texture. I also recreate the illusion of the Montgomery glands and texture of a natural areola. When I reveal the results to a client, the first reaction is stupefaction — they can't believe how real they look. In some cases, clients have said that they look better than the real one they had. 

__The AEDITION:__ *How do the tattoos impact clients’ confidence?*

__DB:__ When a person is diagnosed with breast cancer, it is one of the scariest times of their lives. It can change them completely, particularly physically. Once a person has beaten cancer, they can focus on rebuilding themselves emotionally and physically, so restoring their physical femininity definitely has a positive effect. This is the final step of breast reconstruction, post-mastectomy. The emotional toll of not having nipples is important. Often, at the time of the reveal, they are so overwhelmed by happiness, they start crying. They are elated and say they feel complete and like a woman again. 

Clients have told me that they are no longer reminded of what happened to them, and they are able to move on with their lives. In many cases, they are ready to live a normal life again — being able to undress at the gym, to go to the beach, or start a new romance. They all have one thing in common: They want to leave the past behind.

In this society of filters and social media perfection, the impact of losing vibrancy, beauty, femininity, and the original or natural beauty of features like breasts is even more painful. My work gives them back a sense of normalcy by giving them back what was taken away by a truly traumatic and life-changing situation. They feel like they can face mainstream society again with confidence.

The impact that this 3D nipple-tattooing has on body image, self-esteem, emotional wellbeing, intimacy, and relationships is undeniable. It's a very emotional experience for my clients, and I am proud to contribute in some way to helping erase the constant reminders of a bad chapter in their life. As an artist on a live canvas, my mission is always to recreate the look of normalcy as artistically and scientifically possible.

__The AEDITION:__ *Do you often hear from your clients after you finish working with them?* 

__DB:__ I do! "I never thought I would feel whole again" are not words to a song, but a common phrase I hear from the many women I have helped after breast cancer. It's a very emotional experience for my clients, being able to erase the constant reminder of a bad chapter in their lives. A client recently shared: "The 3D areola gave me my confidence back, which I needed after everything that happened. It made me feel more comfortable looking at myself in the mirror. Now I feel confident enough to date again and get on with my life."

__The AEDITION:__ *Do you foresee restorative tattoos becoming a more common part of the reconstructive and recovery process?*

__DB:__ Surgeons and doctors see valuable benefits with this procedure. It's also now a legal requirement to provide reconstructive procedures — medical insurance companies must cover the cost of the procedure. I am in touch with top cosmetic surgeons locally and globally who want to work in tandem to provide this service to their clients. Oncologists and cosmetic surgeons, nurse practitioners, physician assistants, and counselors all realize there is more to healing than just removing cancer. The emotional and physical scars are painful and are all part of the recovery process to be addressed.

Expert Opinion

Breast reconstruction is an important part of the breast cancer treatment and recovery process. Life-like, three-dimensional medical tattoos now offer patients a non-surgical alternative to traditional areola and nipple restoration.

Interview With Dominique Bossavy About Reconstructive Nipple Tattoos For Breast Cancer Survivors 

Inside The Life-Changing Industry Of Reconstructive Tattoos

yuliya-kosolapova-Zp0VSsp5c5M-unsplash (1)

*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to [BCA](https://aedit.com/aedition/category/breast-cancer-awareness), from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back. *

Now that you have a better understanding of the physical and emotional toll of breast reconstruction and the importance of finding the right surgical team (read our overview of how to approach the breast and nipple reconstruction process [HERE](https://aedit.com/aedition/post-mastectomy-breast-reconstruction-process-breast-cancer)), it is time to dive deeper into the surgical options that exist for post-mastectomy patients to reconstruct their breasts and nipples.

Generally speaking, there are two categories of breast reconstruction: implant-based and autologous tissue (a.k.a. “flap”) based. In some cases, a combination is used to achieve the most natural and symmetrical results. Similarly, there are two main types of nipple reconstruction. One involves tattooing alone, while the other is a hybrid of reconstruction and tattooing.

“I want all of my patients to understand their options so that they can make the best choice for them,” says Nashville-based board certified plastic surgeon [Jacob Unger, MD](https://aedit.com/provider/jacob-unger-md-2649), who performs hundreds of breast reconstructions a year. “And then my job is to give the best result I can under those constraints.”

Here, a comprehensive guide to the most common types of breast and nipple reconstruction.

## __Reconstruction With Breast Implants__

The most popular form of breast reconstruction, breast implants offer a shorter surgery and recovery time than other reconstructive procedures. Implant reconstruction can either be delayed (performed in the months following mastectomy) or direct (performed in conjunction with the mastectomy surgery), and medical advances — like skin-sparing mastectomies, cohesive gel silicone implants, and internal support technologies like [AlloDerm](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4184054/) and [GalaFLEX mesh](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070449/) — have allowed surgeons to create increasingly natural-looking results.

Despite the popularity, the technique is not without fault. “The challenge with implant-based reconstruction is that there is no natural soft tissue of the breast to help camouflage and contour an implant or to help rearrange tissue and nipple position in the same way that you can when there’s native breast tissue,” says Dr. Unger.

With that in mind, it is important to understand the different facets of implant-based reconstruction.

### __Pre-Pectoral Implant Placement__

While [breast implants](https://aedit.com/procedure/breast-augmentation-with-implants) (both reconstructive and cosmetic) have historically been placed under the pectoral muscle to help achieve a more natural look, the trend is now toward pre-pectoral (read: over-the-muscle) placement. 

“Pre-pectoral implants allow for an easier recovery with less pain and discomfort,” says UCLA board certified plastic surgeon [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449). Another perk? The lack of animation deformity. “When you have an implant under the pec muscle and you flex it, and it makes things look a little off,” he shares.

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/4kGyMFWGZDViCo4RyAozgb/7b738a9b9c468daccac9743810d02f07/JacobUnger__1_.jpg}>
A before-and-after of Dr. Unger's pre-pectoral breast reconstruction following a nipple-sparing mastectomy.
</CaptionImg>

Ideal candidates for [pre-pectoral placement](https://aedit.com/procedure/pectoral-implants) are those with younger, thicker skin, which better camouflages the implant directly below. Technique is also important. “Wrapping the implant in a dermal matrix (sterilized cadaver skin) allows you to contain the implant well and gives it an extra layer of coverage,” Dr. Roostaeian notes. “But the most important technique we use to disguise the implant is fat grafting.”

Rather than using an implant alone, plastic surgeons will often recommend a hybrid procedure that involves harvesting fat from a donor site (think: the belly, flanks, or inner thighs) to be injected around the breast implant. The result? Smoother and more natural-looking breasts.

“Fat grafting has changed the way I do breast reconstruction,” says Beverly Hills-based board certified plastic surgeon [Leif Rogers, MD](https://aedit.com/provider/leif-rogers-md-578). “It can improve the outcome of any breast reconstruction, creating a more natural appearance and giving me the ability to fine-tune my results in a way not previously possible.”

Additionally, Dr. Rogers has been having success with a new liposuction-alternative called [Renuva](https://www.mtfbiologics.org/our-products/detail/renuva). “Renuva is a biological allograft product that stimulates your body to grow its own fat cells,” he says. “This would be an ideal product for small contour irregularities after breast reconstruction as opposed to using a patient’s own fat.” 

### __Delayed Reconstruction Using Implants__

Depending upon a patient’s individual anatomy and treatment plan, he or she may choose not to combine their mastectomy and reconstruction procedures. Similarly, surgeons may recommend delaying the placement of permanent breast implants until a later date for better results. 

In such cases, tissue expanders are sutured into the breast pocket immediately following the mastectomy. In the weeks and months following the surgery, the expanders are gradually inflated in a plastic surgeon’s office using air or saline. “A tissue expander preserves the space where the breast needs to be,” says Dr. Unger. And, since placing a heavy silicone implant into an empty breast pocket would compress the fragile blood supply that remains post-mastectomy and lead to tissue death, he notes that the tissue expander “allows the mastectomy flaps to rest without putting undue weight there.”

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/QWzB5aIWpQK0olqHTiNQD/617149c0afa434bc6b455775044c2c95/dr_jason_plastic_surgery_breast_reconstruction_subpec_implant_f__2_.jpg}>
  A before-and-after of Dr. Roostaeian's unilateral subpectoral breast and nipple reconstruction.
</CaptionImg>

Although the expansion process can be uncomfortable, tissue expanders have the additional benefit of giving both plastic surgeons and their patients time to home in on an aesthetic goal. Once the expanders reach the appropriate size, they are exchanged for permanent breast implants. Dr. Roostaeian’s patient Caroline* (diagnosed at 39) admits that the expanders proved to be a necessary evil. “My expanders didn’t look natural, and were sometimes very painful after they were filled,” she recalls. “But they helped me get a really good idea of what size implants would ultimately be best for me.”

After years of monitoring benign tumors and then a cancer diagnosis at age 31, Dr. Unger’s patient Laura says she chose a nipple-sparing double mastectomy because of the quality of reconstruction available today. “I was tired of the breasts I had, but I wasn’t ready to give them up completely,” she confides. “I was really lucky because he was able to place the expanders on top of the muscle, which was a lot easier recovery for me.” 

Laura chronicled her journey on Instagram [@laura_birdwell](https://www.instagram.com/laura_birdwell/?hl=en) and her blog, [tatatocancer](https://tatatocancer.blog/), and, once her expanders were filled, Dr. Unger exchanged them for permanent implants and performed simultaneous fat grafting. Like many reconstruction patients, Laura then had an additional surgery to further refine her results. “I think they look better now than they did before,” she says of her breasts.

### __Direct-to-Implant Reconstruction__

In some cases, women can skip the expander step by having their permanent breast implants placed immediately after their mastectomy. With its promise of only one surgery (which means less anesthesia and recovery time), the direct-to-implant option is understandably appealing — though it’s not for everyone. 

According to Dr. Unger, good candidates are usually women with “smaller, ideally shaped breasts,” who “want to be close to the same size, are very healthy, and have very robust mastectomy flaps” (read: ample blood supply). 

Hayley, diagnosed at age 30, initially had a lumpectomy. “That gave me time,” she says of the procedure. “They got the tumor out, and found out it hadn’t spread.” In her search for a highly skilled surgeon with experience performing pre-pectoral, direct-to-implant reconstruction, Hayley found Dr. Roostaeian after interviewing five or six surgical teams.

During this kind of reconstruction, Dr. Roostaeian uses a new fluorescence imaging technology called SPY to evaluate blood flow right in the OR. “It’s another tool in our arsenal to help ensure the long-term success of the reconstruction,” he says.

Kelly, diagnosed at 45, opted for a unilateral mastectomy and immediate reconstruction with Dr. Rogers. “I had cosmetic implants, and I really liked how I looked before,” she shares. “Whether or not to have reconstruction was never a question in my mind.” 

She was able to undergo a sub-pectoral, direct-to-implant reconstruction, in part because she already had breast implants placed under the muscle. Dr. Rogers also replaced the implant in the non-cancer breast to ensure symmetry, and Kelly ended up having a couple of subsequent surgeries — including fat grafting and nipple reconstruction — for further refinement. Eight years later, she is still very happy with the results. “You can’t even tell the difference,” she says.

While there are plenty of direct to implant success stories, there is also risk. Because of the fragile nature of post-mastectomy skin flaps, many surgeons prefer the two-stage (expander followed by implant) process. “Everybody wants less surgery. Everybody wants to be done and have it behind them,” says [Michael Newman, MD](https://aedit.com/provider/michael-newman-md-795), a board certified plastic surgeon at South Bay Plastic Surgeons in Torrance, CA. “But it’s more important for me to give them a more durable, long-term result.” He prefers using a tissue expander because “it’s very light” and “doesn’t put any pressure on the skin or the mesh,” which “allows the sutures to heal.”

Additionally, the procedure is seldom as ‘one and done’ as it sounds. Patients almost always require additional surgeries to achieve their aesthetic goals. “Direct to implant is a nice concept,” says Dr. Unger, “But the vast majority of the time, you’re going to need to go back to the operating room to touch things up or round things out or add some fat.” 

## __Flap Reconstruction__ 

Autologous tissue reconstruction — more commonly known as “flap surgery” — involves the transfer of tissue from one area of the body (i.e. a donor site) to the chest to create a breast mound. Surgeons can either shift the tissue from one area to another, leaving the primary blood supply of the donor site intact (a.k.a. a pedicle flap), or completely remove the tissue from its original spot and reattach it to the chest in a free flap procedure. 

Free flaps require intricate microsurgery, during which plastic surgeons suture blood vessels together under a microscope to re-establish the blood supply between the donor tissue and the chest. It’s meticulous and time-consuming work (bilateral free flap surgeries can take up to 12 hours to complete), and patients are closely monitored in the hospital for up to five days post-op to ensure the flap is viable. 

The recovery process can be more complex than implant surgery because patients have multiple surgical sites to contend with (the chest and the donor area), though patients report similar pain and discomfort levels with each type of procedure.

### __Types of Flap Reconstruction__

Because of the donor site component, there are a variety of flap procedures for a patient to choose from based on their anatomy and aesthetic goals. The names are based upon the donor sites, including those from the abdomen (TRAM and DIEP), back or shoulder (LAT), inner thigh (TUG), and buttocks (GAP).

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/6tVaTrX0SELcdJYzGiEfbF/430d029fe1f2c807e002d916c354e783/10-16-2019_Editorial_Before-After_BreastReconstruction.jpg}>
  A before-and-after of Dr. Newman's bilateral DIEP flap breast and nipple reconstruction.
</CaptionImg>

Among the plastic surgeons we interviewed, the most popular flap surgeries are the latissimus dorsi (LAT) flap and the deep inferior epigastric perforator artery (DIEP) flap. While a LAT flap is often used in conjunction with a breast implant reconstruction for better results, the DIEP is a free flap procedure that removes abdominal skin and fat only (similar to a tummy tuck) to create a breast mound. 

#### __LAT Flap__
- __Donor Site__: Composed of muscle, skin, and fat from the back
- Type of Flap: A pedicle flap (it remains attached to its primary blood supply)
- __Scarring__: Creates a donor site scar along the back that can usually be concealed in the bra line and an oblong scar around the new breast mound
- __Surgery Time__: 5 to 7 hours, on average 

#### __DIEP Flap__
- __Donor Site__: Composed of skin and fat (no muscle) from the abdomen
- __Type of Flap__: A free flap (it is completely detached from its original blood supply)
- __Scarring__: Creates a donor site scar between the hip bones (similar to a cosmetic tummy tuck) and an oblong scar around the new breast mound
- __Surgery Time__: 8 to 12 hours, on average

### __Advantages of Flap Reconstruction__

While flap procedures are more complicated to perform and require longer surgery times, Dr. Roostaeian says they remain the “gold standard” for breast reconstruction because they create a result that most closely resembles and behaves like a natural breast.

Unlike an implant, the new breast mound feels more like a natural breast because it is created with the patient’s own fat and skin. In the case of unilateral reconstruction, the plastic surgeon will be better able to match the new breast to the unaffected breast. Additionally, breasts created from flap procedures can fluctuate in size and shape as a patient gains or loses weight. 

“Flap surgery is ideal for patients who’ve opted for unilateral reconstruction because that flap changes with your body,” says Dr. Roostaeian, who adds that the results are, long term, much more permanent than implants. “When you choose the implant route, you’re basically signing up for more surgeries in your life because implants tend to have some issues down the road.”

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/35Yvu4Q4Y1iyJmiDjQDUHU/9a54e787069024a30d7755bb2ce90c84/Flap_Reconstruction__1_.jpg}>
  A before-and-after of Dr. Rogers' unilateral flap breast and nipple reconstruction.
</CaptionImg>

That lack of future revisions led Marjan, one of Dr. Roostaeian’s DIEP flap patients who was 47 at the time of her surgery, to choose the procedure. “I told him that because I was young, I didn’t want to have to go under the knife in my seventies,” she recalls. 

Dr. Rogers’ patient Meredith* didn’t want breast implants because she thought they’d look unnatural and possibly interfere with her active lifestyle. “When Dr. Rogers explained that the DIEP procedure would be a tummy tuck — replacing my breasts with my own tissue — and I wouldn't have implants, I was all in,” she shares. “I knew it would be a long 12- to 13-hour surgery the day of, but I was ready to go for it.”

Though she was initially concerned about scarring and the longer recovery time, Meredith is “beyond satisfied” with her reconstruction. And, with her nipple reconstruction also complete, she says her breasts appear so natural that it looks like she had a [breast lift](https://aedit.com/procedure/breast-lift) and [abdominoplasty](https://aedit.com/procedure/abdominoplasty) (i.e. tummy tuck) — not a double mastectomy.

Flap surgery is also an option for women whose implant reconstruction failed due to radiation or persistent capsular contracture issues. Dr. Roostaeian’s patient Caroline originally had bilateral, implant-based reconstruction, but radiation damaged her tissue and caused healing problems. “Dr. Roostaeian told me that the only way to permanently address the situation was to have a DIEP flap,” she says. “It was daunting, and I didn’t think I had enough fat, but he was able to create a small breast and augment it with an implant. It’s so natural that I wish I’d had enough fat to do the other side too.”

## __Nipple Reconstruction__

While skin- and nipple-sparing mastectomies have become commonplace, the patient’s diagnosis may not always allow surgeons to keep the nipples intact. This leaves patients with two reconstruction options: tattooing alone or a combination of surgical reconstruction and tattooing. 

In the former, a medical tattoo artist matches the new nipple and areola to the existing one (after unilateral mastectomy) or creates two new nipple/areolar complexes based on the patient’s aesthetic preferences (after bilateral mastectomy). Shading and color variations help create the illusion of depth and projection.

Surgical nipple reconstruction, meanwhile, takes about 45 minutes and can be done either in conjunction with a follow-up reconstructive surgery or alone under local anesthesia. Surgeons use skin from the center of the breast to create a nipple, leaving a small horizontal scar. Patients can then have the areola and nipple tattooed for a more natural-looking color and to conceal any visible scarring.

## __The Takeaway__

Just as no two breast cancer diagnoses are the same, the reconstruction process is a deeply personal experience that patients may choose to undergo when it is most comfortable for them. With that said, understanding the options available prior to having a lumpectomy or mastectomy can ensure the patient ends up with the best results for their anatomy and aesthetic goals. Finding the right surgical team and seeking the support of women and men who have been through the experience can help to make sense of the process.  

*Patient names have been changed

From immediate and delayed implant reconstruction to the numerous types of flap surgeries, The AEDITION has compiled an in-depth guide to post-mastectomy breast and nipple reconstruction.

A Comprehensive Guide To Breast Reconstruction And Nipple Reconstruction

A Comprehensive Guide To Breast And Nipple Reconstruction

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*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to [BCA](https://aedit.com/aedition/category/breast-cancer-awareness), from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back.* 

From the emotional toll to a whirlwind of appointments, testing, and treatment options, a breast cancer diagnosis can bring a flurry of confusion and fear. Each aspect comes with its own impact — not only on a woman’s health, but on her sense of self. Fortunately, early detection and advances in both technology and surgical techniques have created better breast reconstruction options that help patients to feel like themselves again. 

To better understand the intricacies of the mastectomy and breast reconstruction process, The AEDITION spoke to leading plastic and reconstructive surgeons and their patients about the logistical, physical, and emotional aspects of breast reconstruction — whether it’s finding the right surgical team, understanding what the results will look like, or learning how to heal (physically and emotionally) after surgery. 

## **Finding the Best Surgical Team**

Although it can be hard for a woman recently diagnosed with breast cancer to focus on the long term, the success of her breast reconstruction may ultimately depend on it. “Some patients are so focused initially on getting the cancer out that they don’t really explore the options for reconstruction,” cautions plastic surgeon [Michael Newman, MD](https://aedit.com/provider/michael-newman-md-795), of South Bay Plastic Surgeons in Torrance, CA. “But then they get to that stage when the cancer is out, they’re feeling better, and they really want a better result.” 

When that happens, they often try to find another surgeon, and Dr. Newman says he treats a fair number of patients seeking a revision after surgery elsewhere. While he is able to help the majority of such patients, it is not the most optimal way to do things. 

“There are a lot of breast surgeons who don’t leave the best tissue behind for the plastic surgeon to work with. When there’s a limited amount of tissue to work with, even the best plastic surgeon can’t do a great job,” he says. “It’s better to optimize their reconstruction from the beginning because they end up with a better final result.”

In order to do so, Dr. Newman recommends women take the time to find the best breast surgeon, so they can “set the stage for an ideal reconstruction.” In a perfect world, he says patients should visit a plastic surgeon at the outset to get a referral for a breast surgeon (though it generally happens the other way around). But, if a patient has already chosen a breast surgeon, Dr. Newman suggests asking her plastic surgeon if that doctor is someone they’ve worked with in the past.

The key, according to Dr. Newman, is to find a breast surgeon capable of achieving a balance between removing all of the breast tissue and leaving an adequate amount of skin, fat, and blood vessels behind to support the reconstruction. And he says you shouldn’t be shy about asking your breast surgeon about their experience level and their philosophy regarding tissue removal. 

Another piece of advice? Find support.

Dr. Newman advises women to seek out breast cancer support groups (often offered at hospitals) for advice on which doctors to choose. “When you talk to other people who have been through it, they’ve not only had their own experiences, but they’ve heard from other people too,” he shares. 

Once you’ve found your team, the next step is determining the best course of action for your diagnosis. 

## **Removing the Cancer: Lumpectomy vs. Mastectomy**

Deciding on a breast cancer treatment plan often depends on the type and stage of the cancer, the philosophy of the doctors, and the patient’s own goals and preferences. 

During a lumpectomy procedure, a breast surgeon removes only the tumor, leaving the rest of the breast tissue intact. Less invasive than a mastectomy, a lumpectomy may not have a noticeable impact on the size and shape of the breast — though a growing number of patients are opting to combine the procedure with aesthetic surgery.

“Women with very large breasts who are getting lumpectomy surgery sometimes are getting [breast lifts](https://aedit.com/procedure/breast-lift) or [breast reductions](https://aedit.com/procedure/breast-reduction) as part of that surgery,” says Dr. Newman. “It’s either to make them feel more comfortable, more symmetric, or to facilitate their secondary treatment such as radiation.”

Additionally, Dr. Newman has noticed that younger women are increasingly choosing to undergo a mastectomy — either unilateral (one breast) and bilateral (both) — during which the surgeon removes all of the breast tissue (read our comprehensive guide to the surgery [HERE](https://aedit.com/aedition/what-to-expect-before-during-after-mastectomy-breast-cancer)). “As breast reconstruction results have improved, patients are more likely to move towards a mastectomy or even a double mastectomy than they had in the past,” he says. 

Historically, surgeons removed the breast tissue, nipple, and much of the skin, but the rise of nipple- and skin-sparing procedures have been game-changers for breast reconstruction results. During a nipple-sparing mastectomy, the breast tissue is essentially scooped out, leaving the outside of the breast (nipple and skin) virtually intact. “You don’t have to sacrifice the most difficult aspect of the breast to reconstruct,” says Nashville-based plastic surgeon [Jacob Unger, MD](https://aedit.com/provider/jacob-unger-md-2649), of the technique. “To create a nipple, you either need to get a tattoo, which leaves no projection, or reconstruct one, which leaves scarring in the center of the breast.” 

According to Dr. Unger, who performs several hundred breast reconstructions per year, data shows that, in most cases, leaving the nipple and skin intact does not adversely impact a patient’s long-term prognosis — but it can do wonders for the post-surgery outcome. Sparing the nipple and concealing the surgical scar in the breast fold allows surgeons to create the most natural-looking results. 

## **Types of Breast Reconstruction**

Generally speaking, there are two categories of breast reconstruction: implant-based and autologous tissue (a.k.a. flap)-based.

- __Implant__: Most commonly used thanks to its shorter surgical and recovery time, implant-based reconstruction can be performed in conjunction with a mastectomy or at a later time and involves using an implant to recreate the breast. 

- __Autologous Tissue__ (a.k.a. Flap): In this procedure, the surgeon utilizes the body’s own tissue to construct a breast mound by transferring tissue from one area of the body (known as the donor site) to the chest.

Sometimes, a combination of the two is used to achieve the most natural, symmetrical results. “I want all of my patients to understand their options so that they can make the best choice for them,” says Dr. Unger. “And then my job is to give the best result I can under those constraints.”

Creating a natural *and* symmetrical result can be challenging — regardless of the type of mastectomy or breast construction technique performed. In patients who opt for a unilateral mastectomy with an implant, for example, it is difficult to match real breast tissue to the standard shape of an implant. 

A patient’s unique anatomy, meanwhile, can pose challenges for reconstruction after a bilateral mastectomy, too. “People aren’t always even between their two sides,” UCLA plastic surgeon [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449), points out. “We want the best aesthetic results, but there are a lot of variables out of our control: how the mastectomy was performed, whether they are planning to have radiation, the structure of their ribcage — all of these things that nobody really ever thinks about.”

While surgeons take all of these nuances into account, there’s no such thing as perfection. In fact, relying solely on measurements — particularly for things like nipple placement — can leave a patient with an unnatural result. “The good news is that since nobody is perfectly symmetric, it’s more about making each breast look good on its own,” says Dr. Roostaeian. “They are sisters, not twins.” 

Ultimately, the surgeon’s well-trained eye is paramount because the reconstruction process is equal parts art and science, and managing a patient’s expectations is key. “Women who are undergoing breast cancer care today are expecting and hoping for results similar to aesthetic breast surgery,” says Dr. Unger. “It’s about having appropriate expectations and having good lines of communication.”

## **The Emotional Impact of Breast Reconstruction**

While a successful breast reconstruction can have a tremendous impact on helping women start to feel whole again after a cancer experience, the path isn’t always smooth or linear. It is not uncommon for reconstruction patients to experience some degree of post-surgery depression and seeking help through support groups or therapy can make a big difference. 

Dr. Roostaeian’s patient Marjan was ultimately very happy with her flap surgery, but it was emotionally challenging at first. “I started getting really emotional,” she says of her experience, which included a flap procedure, refining surgery, and nipple reconstruction. “I was regretting not getting the double mastectomy because I was afraid I’d have to go through all of this again.”

Initially, she says that every time she saw herself in the mirror, her unaffected breast reminded her of what she’d lost, but Marjan sought therapy and eventually came to terms with her new appearance. “I changed my perspective, my outlook on body image,” she shares. “When I see people now who look different, it doesn’t phase me. It’s just normal.”

Hayley, meanwhile, chose a pre-pectoral, direct-to-implant reconstruction in part because she wanted to be done with the process sooner. “I wanted to move on with my life, to feel like my old self again,” she says. But months after her treatments, Hayley experienced symptoms that her oncologist said were long-lasting side effects of everything her body’s been through. “Even though I know that I’ll never truly be my old self after going through something really scary, I grew a lot from it,” she says of her experience.

Caroline* also went through a period of conflicting emotions after her reconstruction. “It hit me at the end,” she says. “You’re so focused on getting through all of the terrible parts — mastectomy, chemo, radiation — to reach this goal of reconstruction, and, when you get there, you have to come to terms with the fact that no matter how well they put you back together, it’s not the old you. You have to learn to embrace the new you.”

One thing that can help give patients peace of mind is knowing that they had the best care. Dr. Unger’s implant reconstruction patient Laura, who chronicled her breast cancer journey on [Instagram](https://www.instagram.com/laura_birdwell/?hl=en) and her [blog](https://tatatocancer.blog/), says that finding the right plastic surgeon helped her get through an otherwise incredibly challenging time. “When you’re going through everything, and you’re losing your hair, it’s just such a comfort,” she says. “I call him ‘the good doctor.’”

Kelly feels the same way about the rapport she built with her own plastic surgeon, [Leif Rogers, MD](https://aedit.com/provider/leif-rogers-md-578). “It’s really important to educate yourself and to find someone you trust,” she says. “It’s a relationship, not a ‘one and done.’” 

*Patient names have been changed

The AEDITION speaks to leading plastic and reconstructive surgeons and patients about the logistical, physical, and emotional aspects of breast reconstruction — from finding the right surgical team to learning how to heal after surgery. 

How To Approach The Post-Mastectomy Breast Reconstruction Process

How To Approach Post-Mastectomy Breast Reconstruction

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*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to [BCA](https://aedit.com/aedition/category/breast-cancer-awareness), from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back.*

[According to the World Cancer Research Fund](https://www.wcrf.org/dietandcancer/cancer-trends/breast-cancer-statistics), breast cancer is the most commonly occurring cancer in women worldwide and the second most common cancer overall globally, with two million new cases in 2018. In the United States, [it is estimated](https://www.breastcancer.org/symptoms/understand_bc/statistics) that one in eight women (or approximately 12 percent of the female population) will be diagnosed with breast cancer in her lifetime. 

The mastectomy plays a large role in the prevention and treatment of breast cancer, and, while The AEDITION has covered what to expect before, during, and after the surgery from a medical perspective (more on that [HERE](https://aedit.com/aedition/what-to-expect-before-during-after-mastectomy-breast-cancer), calling attention to the emotional toll of choosing to remove one or both breasts is just as important.

Here, two women share their deeply personal and resilient experiences with breast cancer, mastectomies, and breast reconstruction. 

## __Rena, 53__
In a six-month period, Rena’s relationship with her body and her breasts completely changed. Her breast cancer diagnosis and subsequent unilateral mastectomy happened very quickly, and she was forced to face her new reality much sooner than expected. Rena made the decision not to undergo breast reconstruction and quickly learned that the subsequent transformation was more emotional than physical. 

“The emotional scars take much longer to heal than the physical scars do,” she shares. “The breasts are symbolic of so much. They’re symbolic of feminine beauty and motherhood. Breasts come with a lot of baggage.” 

Following her mastectomy, Rena felt deep waves of emotion that resembled grief, pain, and sadness. “There was a point after the mastectomy where I genuinely thought I was losing my mind because I was so sad. I felt so unwell. I was in a lot of pain. I didn’t really want to leave the house,” she recalls. “And now I look back at that and go, ‘Of course.’ Grief is going to come your way, and you can name it. Now if I feel sad, I go, ‘Oh yes, grief. I know what that is. It’ll be gone tomorrow. Just having a sad day.’ I don’t have that, ‘Oh my god, I haven’t just lost my breast, I’ve lost my mind’ feeling.”

<PullQuote attributedTo={Rena, 53}>
  “Take an empowered approach and come from a place of strength. You get to decide when you want to take the next steps and how your mastectomy process goes.”
</PullQuote>

Rena says the emotional labor was hard, but learning to sit with it and honor how she was feeling was key. She allowed herself to feel her emotions and didn’t pressure herself to feel strong all the time. The driving force of Rena’s recovery came when she stopped letting the situation control her and instead could respond to what was happening around her.

“Take control of what you can,” she explains. “Take an empowered approach and come from a place of strength. You get to decide when you want to take the next steps and how your mastectomy process goes.”

In the moments before her surgery, for example, Rena insisted on walking into the operating room instead of being wheeled in by the nurses. When she got home, she turned all the full-length mirrors in her house around until she decided she was ready to look at her body again. 

Her advice to those on a similar journey: “As soon as you get that news, the time is now to start saying goodbye to your breasts and thanking them for everything they’ve meant to you and done for you,” she says. “Quickly get it into your head that it’s your choice to do away with your breasts in exchange for your life. I chose to sacrifice my breast in order to live. I know that’s sad, but you can say, ‘I will be sad to lose my breasts, but I want to live.’”

## __Tracey, 45__
Like Rena, Tracey has been on her own unique journey. Her diagnosis was a long time coming because she knew she was at risk of developing breast cancer and was able to anticipate at least part treatment and recovery. Due to her family history of breast cancer, she was screened regularly for the disease and discovered she carried the BRCA1 gene mutation in late 2010. She decided she would preventatively have her ovaries removed and undergo prophylactic (a.k.a. preventative) mastectomy and breast reconstruction procedures at the same time.

“If I just had a mastectomy, I know I personally would not have felt feminine,” she shares. “Because I was doing elective surgery, I was lucky enough to be able to consider this option and have the two procedures done together.”

Opting for an immediate reconstructive surgery gave Tracey the opportunity to feel like she was reclaiming power over her experience, but, post-mastectomy and breast reconstruction, she experienced a series of complications and side effects that prolonged her recovery time.

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  “To look at me, you would never know that I’ve had a mastectomy and reconstruction and that I’m going through menopause. I still feel like me.”
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“A few days after the procedure, my cosmetic surgeon noticed that my right nipple wasn’t going to survive, so I had to be taken back in for surgery to remove it. After about a month at home, I got really sick due to an infection in the right breast, and I had to be rushed to the hospital to get the expander out,” she explains. “All up, I think I’ve had about six or seven surgeries now — this includes having the implants put in and a nipple reconstruction on my right breast, which looks great. My left breast is perfect and I’m happy with it. The right one, not so much. But who is ever happy with the way their breasts look? Even naturally, they’re different. I continue to see my plastic surgeon once a year for a follow-up.”

While her road to recovery was a winding one, she remains upbeat about the results. “I’m not affected by it from day to day. Yes, my breasts are hard, one is quite scarred, and one nipple is bigger than the other, but did I make the right decision? Absolutely, 100 percent,” she says. “To look at me, you would never know that I’ve had a mastectomy and reconstruction and that I’m going through menopause. I still feel like me.”

Tracey’s advice to anyone who is considering a preventative procedure or currently undergoing treatment: “I think it’s a personal journey. Everyone is different and has different feelings and expectations,” she says. “My only advice would be to ensure that you do go through all the options of the procedure, have a great surgeon, and surround yourself with a good support group and care team. Try to be positive as much as you can and reassure yourself with the reason why you’re going ahead with these procedures.”

## __The Takeaway __
Rena and Tracey’s experiences prove that there is nothing linear about breast cancer diagnoses and treatment, but hearing from survivors and those who have elected for preventive mastectomies helps to shine a light on the fact that — regardless of your circumstances — the experience is as emotional as it is physical. While finding board certified surgeons who you trust and feel comfortable with is paramount to your medical care, reading about other people’s journeys and creating a strong support system before, during, and after surgery can help to alleviate some of the emotional burden. 

While it is important to know what to medically expect from a mastectomy, understanding the emotional toll of choosing to remove one or both breasts is equally vital. Here, two women share their deeply personal and resilient experiences.