Medical tattoos serve a greater purpose than body art

Not only are tattoos more popular than ever, they’re also mainstream. Along with professional athletes and the occasional celebrity, Average Joes and Janes are getting illustrative body art in increasing numbers, with young people, black people and women leading the inking brigade.

A recent Pew Research Center survey found that 39 percent of black Americans have a tattoo, compared to 35 percent of Hispanics, 32 percent of whites, and 14 percent of Asian Americans. More than half (56%) of American women ages 18 to 29 have at least one tattoo, and women are now outpacing men in getting permanent body art. Tattoos are no longer taboo – even for people in traditionally conservative professions such as law, investment banking and politics.

But what do most people know about medical tattoos?

Medical tattoos serve a purpose; they are not there just to look pretty. For cancer patients, they can mark an area for radiation therapy or other treatment. And paramedical tattoos serve both style and function, covering skin or scalp changes due to health problems, scars, burns or surgery. With medical tattoos, the age-old art of body illustration is put to practical use, restoring visual integrity while aiding emotional and psychological recovery.

Unlike tattoo parlors and salons, in-hospital tattooing must meet higher standards of sterilization, and professionals use medical-grade ink and mineral pigments and smaller-caliber needles. But the procedure is basically the same: small spheres of pigments are deposited in the upper layers of the skin.

So how can medical tattoos be used?

Tattooing with radiation therapy

In some cancer treatments, tattoos mark the places where radiation is to be administered. Permanent tattoos prevent these markings from being removed from the patient between visits. Ultraviolet ink, visible only under ultraviolet light, is sometimes used to mark an area on the skin for later identification or treatment.

“They take all kinds of measurements and make a mold of your body using a soft plastic material that hardens,” said Julia, a uterine cancer survivor, of her treatment last year at Memorial Sloan Kettering Cancer Center’s Department of Radiation Oncology.

“They put four holes in the mold and tattoo a small dot on the skin under each hole,” Julia added, describing a lengthy process called mapping. “Before each round of therapy, they lined up the holes with my four tattooed points to ensure I would be in the same position as before; the ink spots are used to line up the shape and the die is what is used to line up the beams.

Julia, who wishes to remain anonymous, is thankfully now in remission. “I wouldn’t say it didn’t hurt at all,” referring to the small tattoos still on her stomach, “but it wasn’t too painful.”

John Belanich, chief radiation oncologist at NYU’s Langone Department of Radiation Oncology, described a similar procedure for targeting areas to treat breast cancer patients.

“We tattoo four or more small areas – the same size as freckles – to align the lasers in the treatment facility,” Belanich noted. “After marking the spots, we place a drop of ink on the skin and simply scratch the surface with a small-caliber needle. It doesn’t need to go as deep as a regular tattoo.”

Nipple reconstruction tattoos

After mastectomy and breast reconstruction, the tattoo can restore the appearance of the areola and nipple using new 3D techniques. This option helps breast cancer patients who have undergone implant surgery avoid a third procedure to reconstruct the areola and nipple. In fact, some patients choose decorative breast art as a form of self-expression instead of restoring the main areola and nipple.

“More women are choosing to get tattooed to avoid additional surgery, and it’s paying off.” [them] a great result,” said nurse practitioner Leah Hirsch-Cotter, who assisted Dr. Vishal Tanik, a plastic surgeon at NYU Langone Hospital. “However, our goal is to have the best reconstruction for each individual patient,” Hirsch-Kotter added, noting that tattoos provide options that patients did not have even a few years ago.

Some cancer patients forego breast implants altogether, choosing to “flatten out” and get elaborate decorative chest tattoos instead of reconstruction.

“It’s emotional,” said Friday Jones, a talented New York tattoo artist profiled by CNN who has worked for more than 10 years with women who have undergone mastectomies. “Think about a four- or six-hour tattoo – immediately afterwards we’re both relieved it’s done because it’s painful and stressful.”

But the very next moment, Jones notes, these women “see themselves as a stunning work of art; become superhumans. My favorite part is working with women who would [previously] never get tattoos and now we celebrate them.

Seeing their immediate transformation brings her joy: “It’s such a joy to be able to birth these women into this next chapter of their lives,” Jones said.

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Restoration of pigmentation

Remember Michael Jackson’s skin condition? Vitiligo causes the body’s immune system to attack pigment cells, or melanocytes, resulting in loss of pigment. Some, like supermodel Winnie Harlow, celebrate their vitiligo, but for those who wish, tattoo artists can fill in and mask the white patches of vitiligo by using pigments that match their client’s original skin tone.

Paramedic tattoos also cover scars and surgical stitches, including those left after a caesarean section, as well as stretch marks, burns, alopecia, birthmarks and even age spots. Restorative tattoos help people psychologically recover from visible scars after a car accident or other traumatic event. For example, an Illinois tattoo artist posted a photo of nail tattoos he did for a client who lost two fingers in a construction accident. According to The New York Times, the photo went viral and business boomed.

Medical alert tattoos and military tags for dogs

Instead of wearing a medical alert bracelet, some people choose to have critical medical information engraved on their skin. Tattoos can alert paramedics and other healthcare professionals to conditions such as diabetes, severe allergies, heart disease and epilepsy before they begin treating the patient.

Many military personnel have at least one tattoo, and some have their military IDs inked on the torso, under the arm, in case a bomb separates limbs from bodies. For this reason, tattooed dog tags are sometimes called “meat tags.”

Insurance obstacles

It’s not easy to get insurance coverage for “cover-up” tattoos that are considered cosmetic. However, a federal law called the Women’s Health and Cancer Rights Act of 1998 (WHCRA) requires group health plans and individual health insurance policies to provide coverage for reconstructive procedures after mastectomy, including areola and nipple tattooing. However, this law does not exclude complications, delays and impasses before and after filing a claim. Prior authorization is usually required for all diagnostic codes. But many people just pay out of pocket.

However, most would agree that it is worth it because medical tattoos can improve body image and greatly contribute to a patient’s confidence and mental health. Looking good – or at least regaining a sense of normalcy – is deeply connected to feeling good.

“When women who have survived cancer and mastectomies start seeing themselves as this sculpture, as this piece of art,” Jones said, “that’s when it really clicks and they get to the other side.”


Carol J. Kelly is a freelance writer/editor with extensive experience at leading newspapers, including The Wall Street Journal and The Boston Globe. He is currently writing a memoir dedicated to his mother. She lives in Brooklyn, New York.

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