When is Areola Repigmentation a Good Idea?

Areola Repigmentation is one of the easiest procedures to perform. Many technicians say that it is much more simple than performing a full lip color application. Lip procedures can pose challenges such as blue undertones, uneven pigmentation (whether hypo or hyper pigmentation), client’s pain threshold, herpetic outbreaks, lip tissue that may be spongy and excessive bleeding are some of the complications of a full lip colour application.

We feel that areola repigmentation, whether it is just inserting pigment around the white rings around the areola to conceal a light scar to rebuilding a complete areola and nipple coloration, is less problematic than performing a full lip color application.

Breast cancer patients need to be in the right frame of mind when going through the areola repigmentation process. They will look better and feel better about themselves when they can look in a mirror with confidence and see a breast that looks somewhat normal.

Here are some statistics:

  • 12% of women alive today will develop breast cancer.
  • Every 2-½ minutes a woman will be diagnosed with breast cancer.
  • Over 200,000 new cases of Breast Cancer will be diagnosed this year.
  • About 75% of women elect to begin reconstruction when their mastectomy is preformed.
  • 63.3% of cancer survivors lived 5 or more years following diagnoses and roughly 10% lived 25 years or more.
  • In 1992, roughly 11 million Americans, or 6.1% of the adult population were cancer survivors.
  • 41,000 new cases of ductal carcinoma in situ will be diagnosed in 2000, which is the most common type of non-invasive breast cancer in women.
  • Approximately 20%-30% of breast cancers that are detected by mammograms are carcinoma in situ
  • Less than 15% of cancer survivors received psychological support.


Types of breast surgery:

Lumpectomy: a simple procedure to remove a lump or tumor mass.

Partial mastectomy: 2.5 to 7.5cm of tumor mass and surrounding tissue removed.

Subcutaneous mastectomy: removal of all breast tissue except for the skin, areola and nipple that are left alone.

Simple mastectomy: the removal of the breast but leaving the lymph nodes.

Modified radical mastectomy: the total removal of the breast and partial lymph nodes.

Radical mastectomy: total removal of the breast, lymph nodes, pectoral muscles, adjoining fat and fascia.

Extended radical mastectomy: this is the same procedure as the radical mastectomy along with the removal of parasternal lymph nodes.

Staging Breast Cancer

Staging is the process where by physicians use to evaluate the location and size of the cancer area. One of the most important factors is selecting treatment options is identifying the cancer stage.

Staging Breast Cancer

Stage Tumor Size Lymph Node Involvement Metastasis (Spread)
IIIIIIIV Less than 2 cmBetween 2-5 cmMore than 5 cmNot applicable NoNo, or in same side of breastYes, on same side of breastNot applicable NoNoNoYes


Paget’s Disease of the Nipple

Paget’s is a disease of the nipple which appears as a rash on the nipple. Changes in the nipple will usually indicate an underlying cancer in the breast ducts. This is usually just under the nipple and may have extended onto the surface of the nipple.

Breast Cancer in Men

Breast cancer in men is less common than in women and in the year 2000, the American Cancer Society has estimated that there will be over 1,400 new male cases of invasive breast cancer diagnosed.

  • Out of these 1,400 cases of male breast cancer, 400 men will die
  • 1% of breast cancer is from males

Signs of Male Breast Cancer

  • Nipple Discharge
  • Skin dimpling or puckering
  • Abnormal lumps or swelling in either the chest muscle, nipple or breast
  • Retraction of the nipple
  • Scaling or redness of the breast skin or nipple

Breast Implants

We usually wait at least 6 months to create a permanent areola. You can however, (as long as the skin is healed around the areola) create a semi-permanent one while the breast tissue is healing and the relaxation process is taking place. Just make sure to ask if the implant is under or over the muscle.

If the implant is ‘OVER’ the muscle you can puncture the implant if you place the needle too deep into the dermis. Sometimes the skin is so thin it seems that if you just touch the skin with your fingers it will burst!

We like to let the patient draw on what size areola they would like, then we discuss exactly what they are looking for. Some women request really large areolas while others prefer very small. We tell them that this will probably be the only time in their life that they are able to have their “DREAM” areolas. This always puts a smile on their face!!


Tissue to rebuild the nipple can be grafted from the labia, the inside of the thigh, or the back of the ear. Nipple restoration takes place usually a few months after the breast reconstruction. The initial swelling from the surgery is now minimal and the breast tissue has now become more natural looking as the skin’s elasticity has lessened a bit.

Many women choose not to have a nipple reconstructed. They prefer to just have an areola tattooed on with different colouring for the nipple.

I personally think that this is an interesting alternative to having invasive surgery to create a nipple. Patients can purchase ‘semi-erect’ nipples made of rubber. They stick on the breast tissue like a suction cup. If you watched this episode of ‘Sex in the City’… Charlotte gives Miranda a pair of rubber stick on nipples. She puts on her fake nipples and walks through a bar. Heads turn to look at her erect nipples as she created quite a stir with her new look.

Insurance for Patients

Insurance companies are now required by law (as off October 21,1998) to pay for part or all of the costs incurred for a breast reconstruction. This law is the ‘1998 Federal Breast Reconstruction Law’.

To read information on this law look up SEC. 901. SHORT TITLE, the ”Women’s Health and Cancer Rights Act of 1998” (WHCRA). This law is designed to provide insurance coverage to breast cancer patients whose health care plans are not required by state law to cover the costs of breast reconstruction.

Check out these two site http://breastcenter.com/support/insurancestatelaw or http://www.plasticsurgery.org/advocacy/brstlaws to learn about Insurance Coverage for Breast Reconstruction laws in your state.

Every state has different laws pertaining to insurance. For example, in California:

California: enacted in 1978; covers prosthetic devices or reconstructive surgery incident to mastectomy, including restoring symmetry; law was amended in 1991 to include coverage for pre-1980 mastectomies.


To help protect us from cancer, the following 10 fruits and vegetables have superb cancer-fighting properties: Alfalfa Sprouts, Blueberries, Broccoli, Brussels sprouts, Kale, Oranges, Prunes, Raisins, Spinach and Strawberries.

Need for These Services

With all of the breast cancer patients now having the option for Areola Repigmentation, this advancing field is growing faster than any of the other tattooing fields. You can work in concert with physicians or in your own studio or clinic. One of the most rewarding feelings you can have is when you help a patient feel whole again. Remember that men as well as women have the need for these services.

If you would like more information on our Areola Repigmentation class, Areola Repigmentation DVD or our ‘Absolute Perfection’ Pigment Colors, please call IIPC at 800.282.0577 or visit PermanentMakeupSchool.org.