Melissa Kinkade jokes that she likely embarrasses her young sons every day. When they come home from school, they often find her sketching and practicing for her medical tattooing business — drawings that frequently include nipples.
“One of them once said, ‘Mom’s drawing nipples again,’” Kinkade recalled with a laugh. “At first they thought it was funny. Then I explained why it isn’t. These people have been through a lot.”
Kinkade owns OneSeven Hair & Permanent Cosmetics in Columbia, where she has long provided semi-permanent cosmetic services such as eyebrow and lip tattoos. During the COVID-19 pandemic, however, she began applying her skills to a more specialized and deeply personal form of work: nipple and areola complex (NAC) tattoos for people who have undergone mastectomies or other breast-related surgeries as part of cancer treatment or prevention.
“It always stayed in the back of my mind,” Kinkade said. “If a tattoo artist can create a realistic face or eyeball on someone’s arm, then a realistic nipple should be possible. And the need is everywhere. Everyone knows someone who’s been affected by breast cancer.”
Over several years, Kinkade invested in extensive training, taking multiple online and in-person courses while practicing relentlessly — much to her sons’ dismay. Today, she performs multiple nipple and areola tattoos each month for clients from diverse backgrounds. Some are breast cancer survivors discovering the option years after surgery, while others carry genetic mutations that led them to choose preventative mastectomies.
That demand is rising. A 2020 study published in Breast Cancer Research and Treatment found that rates of preventative mastectomy have tripled over the past decade, driven in part by advances in genetic testing.
Dr. Ashley Wilbers, a breast surgical oncologist with University of Missouri Health Care, said she is also seeing more patients diagnosed at younger ages.
“For women with life expectancies of 30, 40 or even 50 more years, we have to consider the long-term risk of developing another breast cancer,” Wilbers said. “That can lead to increased consideration of more aggressive surgeries, including bilateral mastectomies.”
While modern surgical oncology increasingly favors breast-conserving approaches such as lumpectomies, Wilbers noted that these options are not always feasible. When larger surgeries are required, patients may seek ways to reconnect with their bodies afterward.
“There is a real grieving process,” she said. “Women are losing a part of themselves, and how significant that loss is varies from person to person. Reconstruction can be a way to help restore some sense of what was lost.”
Nipple and areola tattoos often represent the final step in breast reconstruction, but they also raise complex questions: Who should perform them — medical professionals or trained tattoo artists? And will insurance cover the procedure?
Stacie Becker, a longtime medical tattoo artist in Florida and owner of Empower Tattoos, argues that the answer lies in collaboration. A qualified medical tattoo artist, she said, must combine artistic expertise with a deep understanding of compromised skin.
“Radiated skin behaves very differently from healthy skin,” Becker explained. “Certain medications change how skin reacts. If damaged skin is overworked, it can stop accepting ink altogether — and a mistake can become permanent.”
Despite the risks, Becker said medical tattooing remains largely unregulated. To address that gap, she is working with Dr. Jeffrey E. Cassisi, a psychology professor at the University of Central Florida, to conduct foundational research and help develop standardized training curricula. She is also part of the National Alliance for Medical Tattooing, a global nonprofit dedicated to professionalizing the field.
Nicole Rizzuto, a former surgical technologist, licensed tattoo artist, and president of the Alliance, said clearer guidelines are essential not only for safety, but also for insurance coverage.
“Doctors have a skill set,” Rizzuto said. “I want a surgeon to do my mastectomy, not my tattoo — and I want my tattoo artist to do my tattoo, not my mastectomy.”
Under the federal Women’s Health and Cancer Rights Act of 1998, most insurers are required to cover breast reconstruction after mastectomy, which should include nipple and areola tattoos. In practice, Rizzuto said, coverage varies widely by state. Some insurers require physician referrals or upfront payment with later reimbursement, while others expect tattoo artists to navigate complex medical billing codes.
In New York, a 2024 law mandates insurance coverage for nipple and areola tattoos — but only if they are performed by a physician or licensed health care practitioner.
“Legally, a chiropractor can do the tattoo and get reimbursed, but a specialized tattoo artist can’t,” Rizzuto said. “Since that law passed, more of my clients have been denied reimbursement.”
Rizzuto added that tattoos performed in medical settings can cost thousands of dollars, even if insurance covers them, while hyper-realistic bilateral nipple tattoos by specialized artists typically range from $600 to $800 out of pocket.
Beyond cost, she said, artists bring a level of collaboration and customization that matters deeply to patients. Tattoo artists can blend dozens of pigments and work closely with clients to recreate details such as wrinkles, folds, and Montgomery glands — the small bumps on the areola.
“They’re going to see those nipples every day,” Rizzuto said. “They don’t see the surgical work on the inside — but this is what they live with.”
For advocates like Rizzuto, the goal is not to replace medical professionals, but to be recognized as part of the broader care team.
“Surgeons already have so much on their plate,” she said. “Let us help. We can work together — and patients are better for it.”
