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  • Medical areola nipple tattooing – industry expert says current standards are unsafe

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    Tanya Buxton is a medical tattoo artist providing 3D areola-nipple tattoos within the NHS and private healthcare. In this Blog, she explains more about her work and how it can benefit a patient post-surgery.

    Tanya also raises a number of safety concerns relating to poor standards of education in this area of healthcare, highlighting the harm this can cause patients both physically and emotionally.


    Areola tattooing

    Areola tattooing is a form of medical tattooing. It is used to recreate a 3D realistic areola-nipple complex (or restore the natural areola-nipple complex), enhancing the results of breast surgeries.

    This highly specialised skill can be used to help patients in their healing journey after mastectomy surgery, gender-affirming surgery and cosmetic breast surgery; promoting body confidence and improving mental wellbeing.

    During the process, high-quality tattoo ink is implanted into the top layers of the dermis skin layers using small sterile needles and specialist tattoo machine. Performing areola tattoos safely and to a high standard requires:

    • various tattooing techniques
    • a high level of artistic ability
    • a thorough understanding of the skin and the tattoo process
    • in-depth understanding of the complex colour theory involved.

    Working on scarred, radiated and delicate skin types takes a great deal of tattooing experience and artistic ability to execute safely and successfully.

    Safety concerns

    Due to a lack of proper education, training and continued support, these tattoos are being performed within medical facilities using unsuitable equipment, techniques and practices. This has resulted in patients receiving poor quality areola tattoos that are, at best, fading away within a few short months and, at worst, causing severe scarring and trauma to the skin.

    As a tattoo artist who understands this tattoo treatment in depth, the poor information and training being given to the medical industry is a huge safety concern.

    Semi-permanent approach harmful

    Many medical professionals and health care providers have been trained to use micropigmentation pigments for areola tattooing. They are told that these pigments are ‘semi-permanent’, vegetable dyes that will eventually disappear. This is completely false information and does not allow patients to provide true informed consent.

    Once pigment (of any kind) is implanted in the dermis layers of the skin (the layers in which a tattoo should sit in the skin) then ‘semi-permanent’ results cannot be guaranteed. What most patients find is that they are left with a faded, usually unnatural in colour, areola tattoo. In most cases this is more distressing to the patient to look at than having no areola at all.

    Using pigment in this way leads people to have regular ‘top ups’ to maintain the tattoo. Repeatedly disrupting the already delicate skin and scarred tissue (particularly after surgery) can result in further damage being done to the skin, which can lead to more scar tissue being created and will cause poor healed results of your tattoo. Pairing this with unsuitable equipment and techniques, increases the risk of damage and scarring even further.

    I think professionals need to be aware that if they perform an areola tattoo poorly and the patient wishes to remove it because it is causing them distress, the removal process is much more difficult than removing a tattoo under normal circumstances. This is due to the delicate skin and flesh tone colours used to create an areola tattoo.

    This is why it is important that permanent tattoo inks are used for areola tattooing. I believe the skin should be respected; areola tattoos should be built to last and completed in as fewer sessions as possible. This helps to make sure the patient’s skin is treated with care and kept as healthy as possible, enabling them to move forward in their journey in a more long-term way.

    Improving safety

    This particular area of patient safety has been a huge passion of mine for a number of years. I have met so many patients who have received poor quality areola tattooing, and are left completely devastated.

    There are ways we can make things safer for patients:

    • I feel it is important to raise awareness to the damage a poor quality areola tattoo can have on a person, not just the physical damage and trauma to the skin but the emotional damage to a person’s well-being and confidence.
    • As a tattoo artist, I also feel it is so important to build a stronger relationship with the medical industry to help more healthcare professionals understand the importance and complexity of areola tattooing and tattoo practices.
    • Proper training, education and continued learning and support is vital to ensure these life-changing tattoos are performed to a high standard of artistry, last as long (and are as realistic) as possible, and are executed safely and efficiently in the skin.
    • Developing stronger practices and processes will help the medical industry include this wonderful service for patients, to the high quality and standards they deserve.

    Final thoughts

    High quality areola tattoos can play a vital role in a person’s healing journey after undergoing procedures such as mastectomy surgery, breast reconstruction and breast cancer treatment. This positive impact has a ripple effect on the patient’s overall well-being and everyday life; enabling them to partake in activities that they may once not have had the confidence to do, such as swimming or undressing in front of their partner. This positive change in the patient also impacts the patient’s family, partner and loved ones.

    For many people, having their areola tattoo marks the end of an important chapter in their personal journey. Having to revisit that period of time in their life with long term, regular ‘top up’ appointments with ‘semi-permanent’ areola tattoos is not a suitable or sustainable approach, not only physically on the skin but emotionally for the client. Not to mention the financial impact on the NHS funding if patients are needed to be seen every 6-12 months for ‘top up’ tattoo treatments, indefinitely.

    If these tattoos continue to be performed unsuitably and to a poor standard, we will inevitably see an increase of patients who have been left disfigured, unhappy with their bodies and suffering from poor mental health.

    Free guide to areola tattooing by Paradise Tattoo Studios.

    Before areola tattoo After areola tattoo

    Before and after photographs of an areola tattoo.                                             

    Share your insights

    Do you work in an area of healthcare and have insights to share around patient safety issues or improvements? Or perhaps you are a patient or carer with insights that could help improve safety if shared more widely? Comment below (sign up first for free) or get in touch with the editorial team at content@pslhub.org.

    About the author

    Tanya Buxton began her tattooing career in 2009. She worked at various studios and conventions all over the world, before opening her studio in Cheltenham in 2021. She is an industry leader in the medical tattooing field and globally recognised for her work. She was the first tattoo artist to work for the NHS and private hospitals, providing 3D areola-nipple tattoos for patients.

    “I have always loved the empowering abilities of tattooing, which led me to progress into more specialised forms of cosmetic and medical tattooing treatments, including 3D areola-nipple tattoos, permanent makeup and scar camouflage tattoos”.



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