When breast cancer invaded Marianne Sarcich’s body last year, she was forced to have a unilateral mastectomy, losing her whole breast on the right side. She has had reconstruction surgery since then, but the implant didn’t make her feel like herself. Ever since she then, she’s been trying not to look down. A year passed and she didn’t know what to do—but now she has her answer.
Last month, Sarcich went to Perelman Center for Advanced Medicine in Philadelphia for a 3D areola and nipple restoration, which would make her reconstructed breast look more like her other breast. This wasn’t surgery, however. In fact, it was the sort of thing that Sarcich never thought she’d end up doing. She was getting a tattoo.
“You OK?” asked tattoo artist Mandy Sauler.
“I’m just so happy this is finally happening,” Sarcich told her.
Sarcich had found her way to the University of Pennsylvania’s Sauler Institute of Tattooing. The office’s cosmetic procedures range from permanent eyeliner and filled in eyebrows to camouflaging scars. Yet it’s the areola and nipple restoration that really brings people in. For survivors like Sarcich, it’s usually their last breast cancer-related treatment, serving as a form of closure.
Some women have a fake nipple created surgically and a tattoo artist colors the area around it. But Sauler’s 3D tattoos use a micropigmentation (a permanent tattoo), to make a tattoo that looks nearly identical to a woman’s real nipple.
Sauler’s mother was a tattoo artist in Downingtown, Pennsylvania. She spent a lot of time in her Mom’s shop—where she performed her first tattoo at age 14. Later she became a licensed tattoo artist. And, despite some naysayers in her life, the more she heard about cosmetic tattoos, the more she wanted to pursue them in her career.
“I feel like with tattooing … the medical portion found me,” Sauler said. “I was kind of meant to do it.”
Sauler flew to Florida in her mid-20s to train with a cosmetic tattoo artist. She learned quickly and began doing lips, eyebrows, eyeliner, scar camouflage, and nipple tattoos at two different offices. Many doctors called for her services—but then UPenn emailed her. She’s worked there for the past six years and has offices in both New York and Jersey, attracting patients from all over the country.
The artists’ secret to success was bringing together the tattooing and medical worlds together. Many doctors and nurses were performing cosmetic tattoos—but they didn’t view the body as a canvas like she does.
“I realized there was no artistry behind it,” she said. “I was a tattoo artist and they were medical. I combined both, and I feel like that’s when the magic happened.”
Sauler’s office doesn’t look like a tattoo shop—it looks like a regular doctor’s office. She even wears scrubs. She began Sarcich’s session by taking measurements of her existing areola and nipple to serve as an outline for her right breast. Next she mixed colors to match Sarcich’s left nipple.
Recently, Sauler started using temporary tattoos for women before they’re put through the final procedure. It’s especially helpful of clients who have been living without one or two nipples for a long time. This is because women who’ve had double mastectomies don’t always remember their nipples’s original shape and color.
When starting the actual tattoo, Sauler fills the circle with the darkest color and adds layers of light colors to create a 3-D effect. She mixes many colors throughout and switches needles for shading. This gives the tattoo some much-needed texture.
The whole procedure took less than 30 minutes, during which Sauler and Sarcich giggled and discussed life, children, and breast cancer. It was all pain-free for Sarcich since there aren’t any nerves in her new right breast.
“Now you have a shiny, new nipple,” Sauler joked when she finished.
Sauler’s services cost between $350 to $700, depending on the person and procedure. While that might seem like a lot for a 30-minute tattoo, you really do get what you pay for. Professor Liza Wu from Penn’s Perelman School of Medicine, praised Sauler’s tattooing skills, saying she brings “a dimension to the nipple reconstruction that we haven’t seen.” It’s also a lot cheaper and requires less recovery time than reconstructive surgery.
When Sarcich’s procedure was finished, she pushed herself off the exam chair, waltzed over to the mirror, and for the first time in a long time, smiled as she looked upon her breasts.
It’s been a long journey for Sarcich, who was diagnosed with Stage 1 breast cancer over a year ago. Her mastectomy was done in September 2016, and she didn’t need radiation or chemotherapy. She was cancer-free—but felt like she lost part of her identity when her breast was removed. Now she feels whole once more.
“If I started with two nipples, I should end with two nipples,” she said.
Cosmetic tattooing is still a very new field with a lot of room for growth and Sauler’s aim is to expand that field as best she can. She has created training opportunities for the estheticians often put in charge of these procedures, helping them to use the right ink and needle sizes.
While it might seem like a niche field now, Sauler hopes one day cosmetic tattooing will be as commonplace as plastic surgery.