What it Means to Be Someone's Final Step

What does it mean to be someone's final step in healing?

For many breast cancer survivors, areola tattooing comes at the end of a reconstruction journey that can take anywhere from 18 months to 3 years. By the time they sit in our chair, they've often endured diagnoses, surgeries, reconstruction, complications, revisions, and years of waiting.

In this episode of Ink & Integrity, Shannon Housley explores the unique responsibility that comes with paramedical tattooing, why preparation matters, and what artists should understand before becoming part of a patient's reconstruction story.

Because when someone has waited years to reach this moment, the work deserves more than a certificate—it deserves proficiency.

If you're a paramedical artist, permanent makeup artist, healthcare professional, or breast cancer survivor, this conversation is a reminder that the final step carries a responsibility all its own.

Honest conversations about permanent makeup, paramedical tattooing, ethics, artistry, mentorship, and raising the standard in the restorative beauty industry.

Hosted by Shannon Housley, founder of Housley Institute and a nationally recognized paramedical tattoo artist and educator.

Follow the podcast on Spotify, Apple Podcasts, and Amazon Music.

Learn more at www.housleyinstitute.com

Transcript

0:03

Welcome to Inc. and Integrity. I'm Shannon Housely, founder of Houseley Institute. This podcast is for artists who care about mastering the craft, protecting their clients, and raising the standard in permanent cosmetic and paramedical tattooing. Today, we're talking about responsibility. Not the responsibility of running a business, not the responsibility of learning a new technique, the responsibility of becoming the final step of someone's reconstruction journey. So do me a favor, close your eyes for a moment. I want you to picture yourself as a paramedical tattoo artist and think about the person sitting in your chair. They're excited, nervous, hopeful, vulnerable. Maybe this is the first time in years they felt like they were finally reaching the finish line. What you don't see when they walk through your door is everything it took to get there. The diagnosis, surgeries, reconstruction, complications, revisions, healing, waiting. For many breast cancer survivors, this journey didn't begin a few weeks ago. It began 18 months, two years, sometimes three years, even before they ever sit in your chair. By the time they get to you, they're not just looking for a tattoo, they're looking for closure. They're looking for healing. They're looking for the final piece of something cancer took from them. And then they finally arrive in your chair. That's why I believe paramedical tattooing carries a much higher responsibility than cosmetic tattooing. Because what most people don't fully understand is the reconstruction journey. That's what I always try to convey to my students. There's the initial diagnosis, which is just a whirlwind of information and questions and worry. And then they may have to do chemotherapy, which could be anywhere from a few months to six, seven months of chemo. If they have radiation, that is something that will always affect their skin. And it can, it can take 20, they can have 25 sessions. They have to go multiple times during a week. It is not a pleasant experience. Then mastectomy, so where they they have their breasts removed. So it could be a unilateral mastectomy where they're just having one breast, or they can have a bilateral mastectomy where they're where they're losing both breasts. Now, there's a lot of things that can occur with this, whether it's a nipple sparing, or if they may lose everything, or they may think they're going in for a nipple-sparing mastectomy and they're excited that they get to keep their nipples, unlike most breast cancer survivors. And then something doesn't go the right way, or the surgeon doesn't see something that makes sense to keep the nipples. And guess what? They wake up in surgery and they don't have any nipples like they expected. If they have smaller breast tissue uh and they they need to be able to fit in an implant, these breast cancer survivors may have to have expanders. Now, what I hear most often is that expanders absolutely suck because they're they're hard. They're like they say they're like wearing a baseball inside your breast. They're just uncomfortable. And so they put these expanders in to gradually expand the skin pocket. So this is something that's probably worn, I would say on average, four months, five months, six months. It just depends on the size that they're actually shooting for. But then every few weeks, they'll go in and they'll have um the, they'll put in either liquid or air, and they are expanding these kind of placeholders for the implants, and it's going to create a larger pocket for that implant to sit in, but it's not comfortable. Not every patient has to do it, but it is something that a lot of people have to go through. Once they get to the point that they're ready for implants, that's another surgery, right? We've already had a mastectomy. And when they do mastectomies, it doesn't always go right into another surgery. Sometimes there's a delayed reconstruction and they do the mastectomy and then there's a reason they have to wait. And sometimes they're able to do the mastectomy and put in the expanders right away. Uh, and then so after they've done that, now they need another surgery, they're going to do a couple different reconstruction options. There's implants, and so they're going to do the exchange. It's a it's a good amount of healing time. You can't lift anything, you have to be very careful. You may have uh drains that you have to wear for uh seven days to 14 days. So, in addition to implants, there's also what's called flap reconstruction. And this is where plastic surgeons take autologous flaps, meaning the person's own skin that's harvested from various sites on the body. One that's really common is called deep flap. DIEP stands for deep inferior epigastric perforator flaps, and that's taken from the lower abdomen. So they're harvesting fat, skin, and blood vessels. It's a complicated surgery, um, and you need a microsurgeon to do it. Then there's also latissimus dorsi flap, where they're using fat skin from the latissimus area, and then there's the tram, T-R-A-M flap, and then there's other areas we take flaps, but they're a little less common where flaps are harvested from the buttocks and the thighs. So flaps are a great reconstruction in terms of they feel very realistic, the skin's more supple, and you don't have to use an implant. So once you complete this reconstruction, you don't have to swap out and implant it, you know, 10 years in the future because there is no implant. So you're you're finished with surgery once all the surgeries are finished. But the downside is flaps are time and healing intensives. It's a lot of healing time. You're going to have multiple drains, and not only are you going to have reconstruction to your breast, but you'll have a surgical site where they've taken the flap skin from. So abdomen, it looks like a Tommy Tuck scar, it's running basically hip to hip, and they take that um skin and fat and blood supply and they put it up in your breast. So lots of recovery from that reconstruction. Then you think you're done, but you're not. And then there's revision. So maybe something didn't heal right. Maybe there's complications as well. Even if you have a great surgeon, it doesn't mean that there's no complications with this. So you may have uh an infection, something may not heal right, your body could reject the reconstruction type, and then guess what? You're going back into surgery right away, and then they're going to figure out what to do with you. Um, there may be additional surgeries needed. And then by the time you finally get to through all of that, then there's nipple reconstruction. And it's not a mandatory thing, but um, if people want the look of protrusion, like you want to actually feel a bump there where the nipple used to be, they're gonna take either a skin graft from your groin area, or if you've had deep flap, they can kind of use some of the deep flap paddles to create a little nipple mound. So, what I'm trying to get you to understand this is not a one and done surgery. This is not a boob job, right? This is a lot. And for many women, reconstruction just isn't a procedure, it's a whole entire chapter of their life. So by the time they arrive in our chair, they aren't looking for another medical procedure. They're looking for closure, they're looking for normalcy and they're looking for themselves. And that's why I believe paramedical tattooing carries a different level of responsibility. Not because it's more important than cosmetic tattooing, not because one client matters more than another, but because these patients have already invested years of trust in surgeons, oncologists, nurses, medical professionals. It's a long process. And the last thing they deserve is an artist who wasn't adequately trained. The biggest misconception I see with new students coming in, and even some experienced artists, is people believing that paramedical tattooing is simply another tattoo technique. It isn't. It isn't something that should be learned online, it isn't something that should be taught in a two-day weekend course. To be prepared to work on reconstructed breasts, you not only need to be adept with the technical skills like machine fundamentals, hand and needle control, uh, needle depth, stretch pressure. You really have to have a thorough understanding of needle configurations and the ways to control pigment implantation. And you also have to understand how to do all of that while working in different scar types, skin thicknesses, compromised skin, radiation damage, and dealing with poor tissue quality. And you have to know how to navigate those pigment retention challenges and working with radiation because that really changes the way that pigment appears in the skin. You have to work with different undertones, skin tones from you might be working on one breast that has an implant and the other one didn't get an implant, it rejected it, and then it had to have basically abdominal skin used in a deep flap to reconstruct that other breast. So you're working on two different skin types. One stretched very tight from the implant, the other breast is uh a little looser, feels more real, but the skin is from the abdomen, and so you're you almost have a yellowish undertone on one breast, and then you have the regular tanned, normal-looking skin on the other one. So that so there's a lot that goes with this. In addition to all of this, you must understand artistic perspective and how to give what I call the illusion of protrusion. So, from an art standpoint, you have to know light source, dimension, uh, visual perception, and and creating the look like there's projection on a flat surface. So you don't have to be classically trained artists to go through these types of training, but you do need to have someone who teaches you this in order to create a realistic looking nipple. Well-prepared artists should also have a medical understanding. Again, you don't have to have a background in medical or healthcare, but your training should teach you the types of reconstruction, um, kind of how it not only what a patient goes through so that you can understand what it's like from an emotional standpoint, but you need to understand the types of reconstruction and how they relate to tattooing. So, tattooing on an implant is way different than tattooing on a deep flap. You also need to know how you're going to work on nipple reconstruction. Basically, you have this mound of skin that is just sitting on the breast that's making this fake little nipple. Uh, they they're great when they are tattooed and they look very realistic, but they are just skin color sitting on the breast. So it's just this little bump. It does not look realistic without some tattooing. And so you really need to know how you're going to put pigment in this little mound of skin. It acts very different than if you're tattooing in regular skin. So there's lots of things that this realm of tattooing you really need to understand in order to master. And I'm just saying artists should be more prepared for dealing with this because women go through so much to get here in the spinal seat, right? Unlike cosmetic tattooing, you also have that emotional care factor. So this is what I think most educators don't teach. You're you're not just tattooing skin, you're working with people who have experienced that trauma, that fear, that loss. They've lost their breast. They've lost sometimes their sense of identity through their breast. And they've gone through years of uncertainty, knowing whether or not they are going to survive and what that outcome is going to look like. It's lost time at work, it's lost summers of fun. You know, if you have if you go through breast reconstruction during the summer, guess what? You're not gonna lay out in the sun, you're not gonna go to the beach, you're not gonna go to the pool. You have scars that you need to keep clean and stay out of water. So I think a lot of people who go through breast cancer lose so much, not just in that trauma, fear, uncertainty. It's also they lose themselves, they lose their lifestyle, they lose that normalcy. And so it's so important for paramedical tattoo artists to understand a little bit of that background and be more compassionate and really dedicate themselves to perfecting this craft because you want to give them the best result possible. The technical skill portion is only one part of serving breast cancer survivors well. You also need the emotional maturity to understand what they've been through. I always like to say the greater the responsibility, the more comprehensive a training should be. And if this patient has spent two years or three years trying to reach this moment, what should we expect from the person performing that final step of the journey? What level of preparation should be required when the responsibility is this high? So when new artists enter the paramedical space today, they're seeing a wide range of educational options. Some are just a few hours long, some are a weekend, and some are done entirely online. And then you have some that are more comprehensive and include hands-on guidance, live models, ongoing support. You know, someone is going to be teaching you all aspects of reconstruction through tattooing. So my concern isn't with the format of the training. I don't care whether it's online. Um I kind of do. I'm going to be real honest. Yeah, it it yeah, I'm not trying to unknock any trainings, but it's really difficult to learn things in a extremely comprehensive way. Um I could include everything that I include in my six-day training on in an online training, and you're just not going to get as much out of it as if you were in person and I'm giving you feedback and hands-on uh correction and feedback. So I know I shouldn't say I'm not trying to knock trainings, whether in the format. So my concern is whether the education matches the responsibility required for this tattooing. Um, I see a lot of very quick, poorly done courses out there for this. I mean, it's across the board that I see with cosmetic tattooing, but you can understand with what women go through with breast cancer, how much greater our responsibility. We owe it to them to be well prepared to deliver the best results possible. And a prepared artist should really understand all reconstruction types, how scar tissue behaves, what the skin does with radiation damage. Radiation can affect not only the quality of the skin, how thin or thick it is, how quickly it gets uh eaten up by the tattoo needles, but the radiation can cause change in color. And so we have to know what we're working on so that we don't do further damage to someone who has waited years to get this done. There's color theory. Uh, you really need to know how pigment works in the skin. Um, because think of it, if you have a unilateral reconstruction, you have to be able to look at your pigments and create or custom mix a pigment that's going to match their unilateral areola, right? We need to be able to give them good results in order to really give them realistic results. We need to understand that color theory and the skin that we're working in. You also need to know how to create that realistic dimension or what I call the illusion of protrusion. So there is some artistic background on that. Again, you don't have to have an artistic background to get into this field, but you have to understand how and why artistic perspective works when we're putting pigment in the skin. You have patient expectations too. Some people are totally fearful of coming in. They, this might be their first tattoo. Maybe their college kid is like, dude, mom, this is gonna hurt. Um, and so I've had a lot of patients come in and they they don't know what to expect, but they are and they've gone through reconstruction surgery, multiple surgeries, but they are so fearful of getting this tattoo because they they have this might be their first tattoo ever. So you have to learn how to control those expectations and manage emotions and and really be there for your patients. Skin also has a lot of different healing variables. So a prepared artist should understand how reconstructed skin may heal differently than regular skin. We're not doing a thigh piece, you know, body art thigh piece here. We're working on breasts that are thin skinned. We may be working in areola tissue that is crinkly paper thin. Um, everything's gonna heal differently. And we need to be prepared as artists to deliver good results, and we need to know that. And then there's that emotional communication. So you need to learn how to read the room with patience. They'll be really talkative. Um, they're asking lots of questions. And then on the other end of the spectrum, you have someone who is shut down, they're defeated, they haven't processed this emotionally. Um, some people deal with this with humor, and some people, this is just very devastating. And, you know, everyone deals with it differently. You need to understand how to handle every emotional situation that your patient is in. So there's so much to know about paramedical tattooing, areola tattooing. If knowing all of those things matters, and it does, then the question isn't whether you've been certified. You know, anyone can get a certificate. The question is whether you've been prepared. I think my final point is that when a breast cancer survivor sits in your chair, you're not just performing a tattoo. You're not just tattooing the skin. You're becoming part of a story that may have been years in the making. And that responsibility deserves more than shortcuts. It deserves more than quick certifications or online training. It deserves preparation. If this conversation made you think, share it with another artist who cares about doing it right. Because in this industry, it's up to us to raise the standard. See you next time.