Tattoos can be final step for women dealing with mastectomies, reconstructive surgery |

Tattoos can be final step for women dealing with mastectomies, reconstructive surgery

JoAnne Klimovich Harrop


Lori Rieger rose from the table where she’d been lying and walked toward the mirror.

“Oh my gosh, Oh my gosh. Oh my gosh,” Rieger says. “I cannot believe this. Can I touch them?”

It was Rieger’s first time seeing the nipple tattoos artist Luke Romaniw created on her chest.

“Oh my gosh,” she says again. “That is incredible.”

That response most likely resonates with women who have undergone mastectomies and reconstructive surgery for breast cancer. The surgery rebuilds the look and feel of their breasts but something is missing — there is no nipple and areola.

Using tattooing techniques, artists create a nipple that helps the breast look more normal.

For Rieger, the tattoos represent the end of a challenging journey. She tested positive for a breast cancer gene mutation and, even though she didn’t have cancer, she wanted to be proactive. She had lost her mother to cancer.

“I am a person of action,” says Rieger of Ross. “I don’t like the wait-and-see-approach.”

Rieger chose to have a double mastectomy and reconstruction.

She soon found a plastic surgeon, Dr. James O’Toole, who talked to her about the nipple tattoos – the first tattoo she’s ever had.

“He said ‘You have a lot of life ahead of you,’” she says. “I knew immediately, he was the one to do the reconstruction.”

Rieger, who is the secretary to the superintendent at North Hills School District and school board secretary, says she’s been fascinated by the whole process.

“I had breasts, but they really didn’t look like breasts,” she says. “I showed them to my friend’s daughter and she said I looked like a Barbie Doll. I said “I am not a Barbie doll.’ I had no tattoos, but I just turned 60 and this was my birthday present to me. I want to feel as womanly as I can.”

“There is a huge mental side to this journey. When I did not feel like a woman, I cried and thought, ‘I can’t believe I did this.’ I felt uncomfortable in my body. It’s not easy. It’s challenging and a life-altering decision. I was fortunate to have a supportive husband, family, friends and co-workers.”

FORMA Naturalis

Cheri Croney, owner of True Image Tattoo in New Kensington, wants to make nipple tattoing service available to all women – even if insurance doesn’t cover it. Her late husband, Kevin, had formed a partnership with O’Toole. She and O’Toole founded a nonprofit called FORMA Naturalis to provide the service.

“We are passionate about doing this for women,” Croney says. “A lot of times they have so many medical bills they can’t afford this because it’s not medically necessary, but we believe it is so important for them mentally, so we want to make it accessible.”

Croney has designated a private room to give women a place where there will be no interruptions and an area that has a feminine feel to it – one of the decorations on the wall reads “Let Your Faith Be Bigger Than Your Fear.”

“To be in the room with them, and see their reaction to the nipple tattoos is something that moves me,” Croney says. “I can’t put it into words. You kind of have to be there.”

Tattoo artist Luke Romaniw creates the tattoos.

“The ladies all seem very happy,” Romaniw says. “This is the final step in everything they have been through. It feels good to be able to give back in some small way. For us, we see it as a tattoo, but for them it is so much more.”

Romaniw uses the same materials and tools as for any other tattoo — he does the measuring and positioning the nipples and areola as well as developing the proper shading to complement a woman’s skin color.

The process can begin three months after the breast reconstruction surgery. It usually takes an hour to an hour and a half to complete. The amount of discomfort is different with everyone since each individual has her own level of pain tolerance and skin elasticity, Romaniw says.

O’Toole says part of his job is to make sure women know they have options after breast reconstruction. Women want to be able to wear their favorite clothes, he said. They worry about being intimate with someone, or simply want to look in the mirror and feel good about themselves.

He has a way of making scars less visible and uses the same incision patterns he does for cosmetic surgery.

“We want to take away those difficult images, so they don’t have to relive it,” O’Toole says. “I tell them, ‘At the end of the day, I am out of the picture, but your life is your life and I want you to live your life and I want to empower you to make the decisions that are best for you.” The potentially devastating effect of mastectomies on women’s sense of self and self-esteem can be mitigated – somewhat – by the tattooing, says Paul Friday, chief, clinical psychology UPMC Shadyside and president, Shadyside Psychological Services.

“This process is becoming more and more indicated and prescribed by surgeons, oncologists and psychologists,” Friday says. “It’s what I would call a ‘positive unintended-consequence’ of a less than mainstream modern social statement. It would fall under my second law of effective (never correct) thinking: Perception is reality.”

He says if the tattooing helps women adjust to life after cancer, then it can only be a positive, self-assertive behavior.

Lisa Kline, vice president of communications for, says via email that there is antecdotal evidence that nipple tattooing is becoming more popular and more people are being trained to do the work, but there are no official statistics as of yet.

The final look

During the hour to hour and half process, some individuals will feel pain, others pressure or not much at all, because everyone has different skin and pain tolerance. It’s all worth it when you see them cry happy tears, says Croney, because they say they look complete when they look in the mirror.

“It means a lot to them, and it feels good to help these women,” Croney says. “Some women are feeling they are at their lowest point, and I know that feeling of loss. It’s not about what you have, it’s about what you are.” Romaniw says he looks at nipple tattoos like it’s another tattoo. He blends colors like he would on any design he is creating.

“It’s about placing the tattoo where it’s pleasing to the woman,” he says. “It’s kind of like the final step. There is a lot of crying and a lot of happiness. When they see the tattoos when they look in the mirror they feel great, and that’s satisfying to me that I can be part of it.”

Romaniw doesn’t make them perfect – he wants them to represent a real woman’s body.

“These women look in the mirror and do a double take,” he says.

Just like Rieger did when she took that first look.


JoAnne Klimovich Harrop is a Tribune-Review staff writer. Reach her at 724-853-5062 or [email protected] or via Twitter @Jharrop_Trib.

Tattoos can often help replace reminders on one's body of self-harm or suicide attempts, or beautify scars from accidents, surgery or injury. A new WQED documentary will explore how ink can change an image and become part of the healing process for some people.
Louis B. Ruediger | Tribune-Review
Lori Rieger waits to have nipples tattooed on her reconstructed breast at True Image Tattoo.
Louis B. Ruediger | Tribune-Review
Tattoo artist Luke Romaniw, of True Image Tattoo in New Kensington, works with Lori Rieger of Ross Township.
Louis B. Ruediger | Tribune-Review
Lori Rieger, Ross Township, pictured with Cheri Croney, owner of True Image Tattoo, New Kensington, and co-founder of FORMA Naturalis, and tattoo artist Luke Romaniw. FORMA Naturalis is a non-profit organization that provides 3D nipple and areola tattoos that replicate the natural breast form, restoring a woman's body to the way it looked prior to surgery.
Louis B. Ruediger | Tribune-Review
Tattoo artist Luke Romaniw, of True Image Tattoo in New Kensington, works with Lori Rieger, Ross Township.
Louis B. Ruediger | Tribune-Review
Tattoo artist Luke Romaniw, of True Image Tattoo in New Kensington, works with Lori Rieger, Ross Township.
Louis B. Ruediger | Tribune-Review
Lori Rieger of Ross Township sits up after having the final step of cosmetic reconstruction of her breasts by having areola and nipples tattooed on her by Luke Romaniw at True Image Tattoo in New Kensington.
Louis B. Ruediger | Tribune-Review
Dr. James O’Toole, double board certified plastic surgeon with expertise in breast cancer care, owner of O’Toole Plastic Surgery in Shadyside and co-founder of FORMA Naturalis. FORMA Naturalis is a non-profit organization that provides 3D nipple and areola tattoos that replicate the natural breast form, restoring a woman's body to the way it looked prior to surgery.
Louis B. Ruediger | Tribune-Review
Lori Rieger, Ross Township, waits to have areola and nipples tattooed on her reconstructed breasts, at True Image Tattoo in New Kensington.
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