Feature
Finishing Touch of a Long Journey It is not a widely recognised end point of a woman’s breast cancer journeyy but medical tattooist Ms Christine Comans is proud to play a vital role in the process. ss. The women who come to medical tattooist Christine Comans are at the end of one hell of a ride sometimes years in the making and not surprisingly, it is a hugely emotional experience for patient and therapist alike. Christine specialises in the tattooing of areolas, the last step for women who have been through breast cancer surgery and breast and nipple reconstruction and all the medical implications those procedures contain. “Cosmetic tattooing is the final component to making the breast reconstruction complete and for many it can provide significant psychological benefits. These women have gone through a lot of trauma and are often quite nervous when they come to see me because they are so close to the end of what has been quite an emotional journey,” Christine said. Women embark on the process of areola tattooing with widely differing motivations. For some it is a destination after a rollercoaster journey through surgery, radiation, chemotherapy and reconstructive surgery; others see it as a necessary step in a process to make them whole again. But few think it will take them back to how they looked precancer. For most, it’s enough to embark on the procedure as cancer survivors and the tattooing procedure is the final mark. Each individual will have their own views about their body image; some are certainly more robust than others, but for Christine,
The Patient’s Story Julia Lee, 37, of Woodvale, and her husband had been home just a week from a two-month adventure in the remote North caravanning with their two daughters aged five and three when she felt soreness and then a lump in her breast back in October 2012. “I went to my GP who ordered tests which came back with not so good news.” That bad news led to a two-year journey that every woman dreads. First her private surgeon performed a lumpectomy and removed three lymph nodes but tests showed that the margins were not clear and there were cancer cells in another lymph node. A further operation ensued but the surgeon was still unhappy and talk turned to mastectomy. “Mum came with me to an appointment and she wasn’t happy that talk revolved around taking my boobs off and making me a nice set of boobs. There was no talk about cancer anywhere else in my body,” Julia told Medical Forum. She was referred to Prof Cristobel Saunders at RPH.
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the emotion comes from giving these women something they want and didn’t have before they walked through her door. “Although some patients are comfortable without having a nipple, and do not wish to have further surgery, others choose the nonsurgical option of cosmetic tattooing without reconstruction. This often allows me to use my skills to simulate the nipple areola without the contour of an actual nipple and is often referred to as 3D nipple areola tattooing. Still, the reconstruction of the nipple areola helps to put the finishing touches on the new breast after a long journey in reconstruction.” Christine usually sees patients three times. The initial consult is to discuss the tattooing procedure and the patient’s preference for colour and appearance and to simulate the expected outcome. “That initial visit also dispels any notion that this is a tattoo shop and eliminates the unknown. Often patients are quite nervous but once they arrive, you can see the relief on their faces. Generally, I will draw on the areola choose colours, discover if they have any sensation and discuss what will happen in detail. “The second visit is the tattooing procedure and how the colour takes depends on the individual’s skin, and where the skin has been grafted from. This visit is about getting colour in the skin and the next visit is more about adding the detail.”
“I had tests for everything and they came out clear but I decided to have a double mastectomy. I didn’t have genetic testing but I have an aunt and a cousin who have both had breast cancer and while I was told that it didn’t put me in a high risk category, I felt I was the one in eight women who got cancer once, I didn’t want to take the chance that it could happen again.” 2013 was a big year for Julia. She had a double mastectomy and implants with expanders were inserted followed by six months of chemotherapy. Two tumours had been discovered, one HR + requiring her to take Tamoxifen for 10 years and Herceptin for 12 months. Her girls watched as she lost her hair, but also in that year she painted the house and was an active school mum. “I don’t know whether it was my age or just because I had young children but I didn’t slow down. It just so happened I had already organised leave without pay for a year from my work as a high school teacher, because the kids were so little, so 2013 was devoted to getting well and being a mum.”
Ms Christine Comans
Christine tattoos the outline of the areola then fills in with the colour, even creating the impression of montgomery tubercules and milk ducts. She also feathers the edges of the areola to give a more natural look.
Later that year, her silicone implants were inserted and early 2014, her nipples were reconstructed. By the end of the year, Julia was booked in to see medical tattooist Christine Comans. Julia, now 40, is grateful to be alive and well for her daughters and her family. Her reconstructed breasts courtesy of RPH surgeon Dr Anna Goodwin Walters, are better, she says, than pre-mastectomy, which after breastfeeding both girls, were never quite the same again. However, she said she was never really fussed about her breasts or her body image after surgery and was spurred on to have the tattooing done by her mother, who wanted to see the end of the process. A big line under the whole traumatic episode. “Tattooing hurt, despite what the doctors said. When Chris was drawing the circles, I could feel that even though I had anaesthetic cream applied. The next visit, Chris applied the cream and sat with me chatting for more than half an hour to make sure the cream worked. That afternoon was a much better experience.”
MEDICAL FORUM