Penn tattoo artist creates 3D nipples, closure for survivors

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PHILADELPHIA — After losing her right breast, Marianne Sarcich practiced not looking down.

The breast cancer that invaded the North Wilmington mom’s body last August forced her to undergo a unilateral mastectomy, losing everything on her right side. She had reconstructive surgery, but the implant didn’t help her feel like herself.

So when Sarcich got dressed in the morning, she avoided looking at her right breast or looking in the mirror. She hated to see the white skin broken only by a pink scar.

Then last month, a year after her surgery, Sarcich found herself at the Perelman Center for Advanced Medicine in Philadelphia, staring at her chest, waiting for a 3D areola and nipple restoration that she hoped would give her breasts a uniform and uniform appearance. She felt a little anxious.

“I’m fine,” asked tattoo artist Mandy Sauler.

“I’m so happy this is finally happening,” Sarcich told her.

Like many others, Sarcich had found his way to the Sauler Institute of Tattooing, which is on the hospital campus of the University of Pennsylvania. The office offers cosmetic procedures ranging from permanent eyeliner and filled-in eyebrows to camouflaged scars.

Tattoo artist Mandy Sauler, who works in the University of Pennsylvania's office of plastic surgery, begins to outline a new areola she will tattoo on breast cancer survivor Marianne Sarcich.

But what everyone is talking about is areola and nipple restoration for breast cancer survivors. For women like Sarcich, it is often the last breast cancer treatment, helping bring closure to a difficult time in their lives.

Some women have a fake nipple surgically created and then a tattoo artist colors the area around it. Sarcich’s 3D tattoos use a optical illusion effect to make it appear that there is a nipple there.

A second-generation tattoo artist, she uses micropigmentation, or a permanent tattoo, to make this 3D nipple look almost identical to a woman’s remaining nipple or the ones she had before surgery.

“I feel like with the tattoo…the medical part found me,” Sauler said. “I was kind of supposed to.”

Sauler grew up in her mother’s tattoo shop in Downingtown, Pennsylvania, and by age 14 she had her first tattoo done. She made stick figures out of another tattoo artist’s scars from knee surgery.

Sauler eventually became a licensed tattoo artist. And the more she heard about cosmetic tattoos, the more interested she became, even though others told her it wasn’t legit.

In her mid-twenties, she saved all her money and flew to Florida to train with a cosmetic tattoo artist. Soon after, she began doing eyeliner, eyebrows, lips, scar camouflage, and areola and nipple tattoos at two doctor’s offices.

Doctors kept calling him for his services. And then UPenn officials emailed him.

Mandy Sauler, founder of the Sauler Institute, one of the world's top tattoo artists for nipple tattoos, tattoos a new areola on Marianne Sarcich's right breast.

Sauler credits his success to his ability to bring together the worlds of tattoo artists and doctors. She discovered that many doctors and nurses performed cosmetic tattoos, but unlike her, she didn’t view the body as a canvas.

“I realized there was no art behind it,” she said. “I was a tattoo artist and they were medical. I combined the two and I feel like that’s where the magic happened.”

For the past six years, Sauler has worked at the University of Pennsylvania Hospital and has offices in New York and New Jersey. While his patients come from all over the country, many, like Sarcich of North Wilmington, received cancer treatment at Penn.

Sauler’s office resembles that of a doctor. She wears scrubs and her patients wear a hospital gown.

At the start of the session, Sauler took measurements of Sarcich’s existing areola and nipple to create an outline on her right breast. She then mixed the colors to match Sarcich’s left nipple.

Mandy Sauler tattoos a new areola on Marianne Sarcich's right breast, which has been removed.  Although she had reconstructive surgery, Sarcich said she didn't feel like herself.

Sauler recently started using temporary tattoos for women before they undergo the final procedure. This is useful for many of her clients, as they have lived without a nipple or two for a long time. Often women who have had a double mastectomy forget the exact shape and color of their areolas and nipples, she said.

When Sauler begins the actual tattoo, she fills the circle with the darkest color and adds layers of lighter colors to achieve the 3D effect. She will mix different colors and change needles to help with shading.

This makes the areola and nipple look like they have texture.

Sauler’s services cost between $350 and $700, depending on the procedure and the person. More and more insurance companies are starting to reimburse tattoos, she said.

Sauler decided to create training opportunities after discovering that some people who do cosmetic tattoos create a nipple by simply filling a circle with orange-pink tattoo ink. Many do not use the correct ink or needle size. She hopes the classes will bridge the educational gap.

Dr. Liza Wu, professor of plastic surgery at the University’s Penn’s Perelman School of Medicine, said it’s rare for cosmetic tattoo artists to have offices in hospitals. Often, it is beauticians who perform the procedures.

Marianne Sarcich of Wilmington shares a laugh as she looks at the before and after photos of her right breast areola tattoo done by Mandy Sauler.

Sauler’s ability to create a 3D effect brings a “dimension to nipple reconstruction that we haven’t seen,” Wu said. It also allows women to forego nipple reconstruction surgery and opt for a simpler procedure with less recovery time, she said.

During the date, Sauler and Sarcich laughed and talked about life, kids and breast cancer. Sauler colored her eyebrows pink that day to honor her client.

Sarcich was diagnosed with stage 1 breast cancer more than a year ago after finding a lump in the shower. She underwent her mastectomy in September 2016 and did not need to undergo radiation or chemotherapy.

She is cancer free but wants to feel whole again.

“If I started with two nipples, I would have to end up with two nipples,” she said.

Sarcich said she was surprised to feel like she had lost part of her identity with her chest. She struggled with anxiety after her treatment and started art therapy. She hopes the tattoo will help her find that part of herself.

She admitted she had never seen herself getting a tattoo, but she is thrilled to bond with her 20-year-old daughter, who has at least three. Sarcich was also looking forward to shopping for some cute bras at Victoria’s Secret to celebrate.

The procedure itself took less than 30 minutes and was painless for Sarcich since there are no nerves in her reconstructed right breast.

“Now you have a shiny new nipple,” Sauler joked when she finished.

Sarcich quickly pushed herself off the exam chair, walked over to the mirror and, for the first time in a long time, smiled at her breasts.

Contact Meredith Newman at (302) 324-2386 or [email protected] Follow her on Twitter at @merenewman.

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