NOTE: A version of this post appeared on October 20, 2013, as Breast Cancer Awareness Month was winding down. The pictures on this post offended someone so much that she or he reported them to Facebook and asked to have them removed. And I thought the cancer was the offensive thing. The story that follows is mine. I chose to share it. I make no apology. I did not choose the cancer that inspired its telling. 

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I don’t remember when tattoos became mainstream, only that I was late to the party. I had never considered a tattoo for myself mainly because of its permanence, the very thing that others find appealing. For the longest time, my mother, the Queen of England, and I were probably the only women on the planet without ink. Then one day, I woke up and everybody was doing it.The British Prime Minister’s wife had a dolphin inked on her ankle, then Susan Sarandon got one, another one and then Dame Helen Mirren got one on her left hand, a reminder, the doyenne of British drama had told the Daily Mail, to love thy neighbor. In a twinkling, tattoos were as ubiquitous as Tupperware, and tattoo parlors no longer at the dark end of the street in the dodgy part of town. On every corner, it seemed, there was either a Starbucks or a tattoo shop; coincidentally, most folks patronizing the latter were adorned with fascinating body art. An avid people-watcher, staring at all that ink on display helped me pass time while waiting for my latte. But just as I was beginning to appreciate the artistry involved, the complexity of the designs, and the inspiration behind them, I became aware of the burgeoning tattoo removal business. Right next to the hardware store, across the street from my local Starbucks, popped up such a place, aptly named Delete. I suppose it makes sense; as the erudite CEO of Dr. Tattoff, explains, “what happens is life changes and that [tattoo] may not represent who you are anymore.” Like high-waisted mom jeans and over-sized plaid jackets with shoulder pads and really big hair, I suppose. Except all three appear to be making a comeback which makes me wonder if those responsible for setting fashion trends have run out of ideas . . .

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I like to think I have a few good ideas left in me and that my life is still peopled with bold, brainy, beautiful women from all generations. There are those in their sixties and seventies, to whom I turn for stories of the way we were or should have been and what we wore and why the hell we are still making so many compromises. Settling. There are the women who went to college with me in Belfast all those years ago, fiery and full of fun, now approaching sixty – sixty – as their daughters and sons head off to make their own marks on the world. In one dizzying instant, the girls with whom I played hopscotch are grandmothers, while I am the only one with a child who just turned 21. Then there are the younger women I encounter mostly in the world of work, some barely 30, infinitely more assured and a lot smarter than I was at the same age, dipping their toes in the education business – a profession that has not lived up to their expectations – wondering if they should take it and make it better, or just leave it.

Within this circle of women, I drew the short straw as the 1 in 8  none of us expected to get cancer, the one in reasonably good shape depending on the eye of the beholder, the one with no family history and clear mammograms. It chills me to know I will not be the only woman in this international circle to be struck by cancer. At the same time, it emboldens me to know we are writing about it, complaining about it – out loud – stomping out those myths and taboos that have for too long duped us within a flourishing breast cancer industry of which we are all aware this month.  Some of them sport at least one tattoo, an inky celebration of something significant to them. Perhaps it is discretely placed on some part of their bodies rarely seen during the work day. A Celtic knot, a Japanese symbol, a butterfly, a dragonfly, a line of poetry or perhaps the initials of names of someone held dear. This last invariably bringing to mind Johnny Depp’s “Wino Forever” tattoo, which prior to a soured relationship with his then-famous fiancee, was “Winona Forever.” This must be true; I read it in People magazine one afternoon while having a pedicure.  A fine example of turning lemons into lemonade and an excuse for including here a picture of the dreamy Mr. Depp.

Some of these tattoos, I will notice entirely by accident, especially those that appear in my professional life. Occasionally an otherwise hidden piece of body art, an exotic bird perhaps, peeks out from behind an errant bra strap or at the nape of the neck of a tired dentist when she scrapes her hot hair up into a ponytail. Once, I spotted an over-sized bandaid on the slender ankle of my daughter’s 2nd grade teacher at a parent-teacher conference. I had assumed this was to camouflage a nick sustained during a hasty shaving of the legs, but some time later, however, the ankle had healed, its bandaid peeled off to reveal a rotund Disney cartoon character with an attitude, home-made and done on a drunken dare by a bouncer in a Los Angeles bar.  I haven’t seen her for years, but that tattoo is indelible in my memory, the kind of thing Tina Fey alludes to in her Mother’s Prayer for her Child in Bossy Pants:

My own issues with permanence notwithstanding, there are other reasons why I am resistant to tattoos. When I was a girl, a tattoo was neither a fashion accessory nor an objet d’art. Early on, it was an annual ceremony involving pipes and drums, broadcast on the BBC to a global audience – the annual Edinburgh Military Tattoo. Eventually, my view of the tattoo expanded to include those designs inked on a human canvas. But far from mainstream, the tattooed boys of my youth were typically stigmatized, viewed from afar as having been up to no good, an unsavory bunch, degenerate, even.  Their tattoos were mostly of the home-made variety, crude and completed on a boring, wet Saturday afternoon when there was nothing else to do, usually by someone who could spell with a safety pin disinfected in Dettol and the obligatory bottle of Quink ink. I remember the quiet girl with mousey hair and freckles, her pale teenage knuckles incongruously spelling out a shaky L.O.V.E. in indigo.

I also recall being in Kellys Cellars in Belfast one afternoon in 1984 where I encountered an interesting – albeit confused – person with UDA tattooed on his left forearm, and IRA on the right.  The only other people with tattoos -(Union Jacks, anchors, daggers, or a combination of all three) were the young men who spent interminable hours leaning against the wall outside the bookies, out of work and, by all accounts, most always out of luck. In truth, these lads were far less menacing than they were emblematic of Northern Ireland’s economic reality in the 1980s and our destiny if we didn’t “keep at the studying.”

Within all this tattoo talk is my own story that will likely offend someone perhaps in the way 50 year old Inga Duncan Thornell’s post mastectomy tattoo caused Facebook to repeatedly remove a picture of it in 2013.

It is one of those “a-funny-thing-happened-on-the way-to-the-end-of-my-breast-reconstruction” kind of story. As I have said ad nauseum, a diagnosis of breast cancer changes everything. Words and relationships take on new colors, different things matter more and less, and what used to be irrelevant may become almost mandatory – like kale. I hate kale. Blueberries. Exercise. A tattoo. A tattoo. The thing I would never have considered. I’m drawn back to the day the best breast cancer surgeon in the universe, Dr. Linda Liu, told me there was no way she would risk not getting clear margins by preserving the nipple of my right breast. It is important to note that at the time, I knew nothing about margins other than how to set them in a Word document. I remember well how she turned her body away from the MRI picture on the screen, folded her arms, and looked right at me to tell me that given the location of the tumor and the smallness of my breasts, it would be horribly disfiguring if she tried to remove the tumor via lumpectomy in order to spare the nipple. Basically, she didn’t have a lot to work with. So she recommended – and I nodded sagely in agreement – a skin-sparing mastectomy which entailed removing only the skin of the nipple, areola, and the original biopsy scar to create an opening through which she would remove the breast tissue. Duly spared, the skin would then accommodate a reconstruction using my own tissue. I didn’t want implants. Along with tattoos, I have a reticence about implants.

I was fascinated by the MRI pictures and began to understand why it would have been possible for mammograms to miss so spectacularly the cancer that had been growing gradually for who-really-knows-how-long – five, ten fifteen years? In the course of a long conversation, I grew increasingly comfortable with and confident in this surgeon. I liked her. We talked about the mastectomy which would happen after the Christmas holidays, which seemed an eternity away, along with a DIEP flap reconstruction which would ensure I woke up after an 8 hour marathon surgery with a new right breast. Sans nipple. Maybe we talked about that. I don’t remember, nor did I have the sense to bring anyone along to listen. Nipples are not really standard conversational fare, except in the inane chatter on Entertainment Tonight, Inside Edition, and television shows of that ilk, and only, apparently, if the nipple in question belongs to Madonna or Janet Jackson or the lead singer of Maroon 5 that had been exposed accidentally and on purpose to audiences all over the world via Youtube.  For me, “nipple” is a frivolous word, the kind that might belong in a limerick, perhaps to rhyme with “Raspberry Ripple,” an ice-cream flavor from my childhood. “Nipple” lacks the gravitas of “malignancy” and other scary cancer words. “Areola” is not a necessarily serious word either, but it evokes a kind of elegance, like a constellation of stars.

Thus my mind wandered, as my patient surgeon described the mastectomy, the removal of My Right Breast, which by that stage, I swear to God, had become the third person in the room. As the information washed over me, much of it technical, I feigned the role of the empowered patient and asked a few sensible questions, the answers to which I would immediately forget.  How long will the surgery would take? How much will it hurt? Will there be lots of Dilaudid available?  Will I need radiation? Will I need chemotherapy? When will I be able to start running again?  It didn’t occur to me to ask about a nipple. A nipple for God’s sake.

Time passed. Slowly. My little trio of a family survived Thanksgiving, Christmas, and the New Year with me in a surreal denial of the following truths:

1. I had invasive breast cancer.
2. I had been married for 21 years. Twenty-one. A lifetime.
3. My baby girl was turning 14.

I wish now that we had expended less energy on the damn cancer and focused instead on a touch of bling for a 21st wedding anniversary – knowing we would only have another year together – or a 14th birthday party for our only daughter, but learning the rules of engagement takes time. And we were frightened. Time spent waiting for surgery passes very slowly. Then not slowly at all, and in a twinkling, the woman looking back at me in the mirror bore a wretched scar that stretched from left hip to right, a repositioned belly button, and a perfectly reconstructed right breast, small like its partner on the left, but instead of a nipple, there was its absence. This should not have been a shock. I knew it was going to happen. I knew that around where it used to be would be a large circle, through which the nipple, the areola, and the right breast had been removed. (See skin-sparing mastectomy above).  Removed. Cut out. Excised. Severed. Amputated. And other scary words.

Not pretty enough? No. Nor for me. This was not the free boob job some people had told me I was so lucky to get. Let me repeat – a mastectomy is NOT  a boob job. If there had been some way to avoid seeing the crude circle of a scar that defined the space through which my breast etcetera had been removed, then perhaps I could have avoided thinking about the cancer. But after every shower, every day, I took a trip down memory lane. Not without some guilt. It is only a nipple, I know, and in the grand scheme of life, it’s a minor detail. The major detail is that my brilliant, funny, warm, physician removed all the cancer she could find; she found the best plastic surgeons to do the reconstruction, and I should have been pleased. I know. I’m lucky. I’ve been told so many times. Except I hated that scar. I couldn’t not see it, and it reminded me that I had a large tumor hiding in dense tissue below it, for a long time. And that enraged me. But not for too long, because there was something akin to a solution on the horizon. That’s right. A tattoo. A tattoo.

In due course, a very nice administrative assistant from my plastic surgeon’s office (there’s a phrase I never thought I would utter) called to schedule my “nipple tattooing.” She asked if I would like Rick or Michelle, and surmising that Rick was probably a man, I asked if it wouldn’t be too much trouble could I please have Michelle. I subsequently felt even better about this decision since Rick apparently bears some resemblance to a jolly Santa Claus erstwhile biker.  Real talk – I just cannot bring myself to discuss nipples with either Santa or a biker. Michelle was a hoot. Following my announcement that this experience would  be on a Most Unlikely Things I Have Ever Done list, much hilarity ensued about all the other things that would surely be on our lists which for obvious reasons cannot be divulged here – I am very sensible after all with a grown-up job. Although some would argue – inexplicably – that some of these might be entirely more appropriate than nipple talk. Regardless, within seconds, I was sharing confidences with Michelle, as you do with a trusted hairdresser until she executes that one really bad hair cut. And then you leave them for another, “the rebound hairdresser,” – but we always go back to that first one who gave us The Best Haircut Ever, but only once. Naturally. 

As Michelle and I surveyed our reflections in the mirror, arms folded, eyebrows furrowed, me topless, we made objective observations about my left nipple, in the same way the Keno brothers appraise something that may once have been of value, on Antique Roadshow which my husband watches every Monday night, convinced there might be something in our house – other than my nipple – worth millions of dollars. With a tape measure to bolster her argument about where the right nipple should be, the lovely Michelle, (and really, she was lovely), pointed out that I am something of a rarity with a small, but let it be noted, “awfully cute” left nipple. Perhaps she thought I wanted more from the tattoo, but when she painted on a vague idea of what it might look like, I almost wept. Immediately, my eyes were diverted away from the scar. Mission accomplished. Almost.

Again supine on a table, I stared at the ceiling, my mind racing all the way back to the early 1970s when Santa – not Rick – but the real Santa brought for me one glorious Christmas morning a Spirograph Set. It might be my all-time favorite gift. I spent hundreds of hours hynoptized by the geometric designs I could create with the handy templates provided therein. Any other spirograph fans will enjoy this old black and white commercial. I digress, but only a little.

Michelle duly numbed the area, using the aptly named “Numpot Gold,” which I mistakenly heard as “Dumbpot Old.” Along with my failing eyesight, which has nothing to do with cancer, is the sad suggestion that I might actually be harder of hearing than I used to be. Trust me. 56 is not a kinder, gentler, newer 36. I resent my aging body, as I’ve said before. Anyway, following the numbing, not that there is any perceptible sensation in the reconstructed breast, Michelle again produced her faithful tape measure and the lime green template reminiscent of my beloved Spirograph set.

Next, there was the selection of colors, a little like settling on hair-color or nail polish. When I go for a pedicure, a treat I only discovered in the late 1990, the most time-consuming part is choosing the polish. It’s not a simple matter of red or pink and every shade in between, but every other color of the rainbow as well.  A creature of habit, I shouldn’t take so long. I should just stick with “I’m not really a waitress,” even though I really was a waitress once upon a time – a good one, too. Every once in a while I’m lured by something like the cheery, summery “Tarot Reader” and its suggestion of foretelling whatever might be in my stars. My daughter will go for “DS Magic,” a bluish sparkly concoction. She is partial to a flower on her big toe, and when the darling Vietnamese pedicurist asks “Would you like a happy toe?” she always responds as though she has never been asked before, ” Ooh, yes, please! Thank you!.” How I love that little exchange between them.

There are other nail polish colors, the names of which are overtly sexual, a fact that annoys me and leads me back to the contents of Michelle’s arsenal. Surveying the various pinkish and flesh toned inks she selected for me, I wondered about the men who are diagnosed with breast cancer every year, and how they must feel about how every facet of this disease has been euphemized, feminized, and glamorized. Even in the face of estimates by The American Cancer Society that approximately 2,670 new cases of invasive breast cancer will be diagnosed in men in 2019 and that about 500 men will die from breast cancer annually, it’s still wrapped up in sugar and spice. I imagined Michelle discussing with a man recovering from a mastectomy, the relative merits of the various inks that would ultimately create a nipple – ‘Kiss Me,” “Baby Lips,”  “Creme Areola,” “Nude Lip Mix.” Seriously.  I wanted to delve deeper into the subject of these suggestive colors and the creative minds behind them, but the issue is so much bigger than Michelle and me. So she went about the business of creating a nipple – it didn’t take long, given the size (see above).

As she concentrated on fashioning my new nipple, I lay there thinking about gender and breast cancer, only vaguely aware of the sound of the needle puncturing my skin. I thought about men with breast cancer and how they must navigate a culture that is decidedly girly with its lipstick-like colors for nipple tattoos, its fluffy pink pillows that help prevent the seatbelt from digging into the tender, biopsied and rebuilt breasts. I even paused to recollect the uber-feminine pink and black “sex appeal while you heal” bra that is just too much bra too soon for someone like me who typically scores a very nice Calvin Klein bra for less than ten bucks at Marshalls, not to mention the bedraggled, traumatized well-medicated 49 year old version of myself, barely able to stand up straight with bloody-fluid-filled JP drains sprouting, alien-like, from her armpit and either hip. But that is another tale for another day. Today it’s about the tattoo and what it can do for you.

Of course, it is October, and we are still being made aware of breast cancer and talking about its early detection through self-exams and mammograms instead of how we can prevent it or the spread of metastatic disease or what causes it in the first place. We are still amputating breasts, and of the 2.6 million individuals living with breast cancer, after surgery 56% are left with unforgiving mastectomy scars and often no nipples. Some woman cover these scars with tattoos, and on October 21st 2013, Fractured Atlas, a non-profit arts service organization planned the first crowd-funded P.INK Day at Saved Tattoo in Brooklyn, New York. Ten of the city’s top tattoo artists inked scar-coverage and/or nipple-replacement tattoos on ten women who have had mastectomies. P.Ink was founded by Noel Franus, an agency executive at Boulder-based CP+B whose sister-in-law had chosen a tattoo following her diagnosis, treatment, and breast reconstruction. P.INK (Personal Ink) is still up and running featuring over 1,000 images of post-mastectomy tattoos on p-ink.org .Finding a natural alliance between those with breast cancer and the tattoo artists – two seemingly disparate communities – it has become “a place for inspiration and hopefully action” for those who have had breasts removed.   

Dr. Claire Buchanan, a breast cancer surgeon with the True Family Women’s Cancer Center at Swedish Hospital in Seattle, has some patients who have chosen a tattoo and says they experience “. . . genuine delight in showing something beautiful about themselves and that’s a wonderful thing to see.”

In closing, for those who would be offended by tattooed nipples or pictures of women whose breasts have been removed, my hope is that you are infinitely more offended by breast cancer and the numbers of lives it will continue to claim until we start having different conversations about it and admitting that awareness is simply not enough.

Not in October. Not ever.

#ThinkBeforeYouPink

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