Saturday, July 29, 2017

Chest Tattoo with a Side of Lymphedema

As a means of healing and prettying up my mastectomy scars, I looked forward to a chest tattoo. I envisioned never wearing a bathing suit top again! After my mastectomy, I asked my surgeon about it. His only concern was that it wouldn't look good when I finally gave in and got reconstruction. But, if I'm absolutely sure I don't want recon work done, then I could get the tattoo as early as six weeks after surgery. That would have been done in December, but we were just about to go to Costa Rica, so I postponed it for after the trip. And then I found out I needed more surgery, so I postponed again. I asked the second surgeon if he had any concerns about a chest tattoo, and he said the same thing, just to wait six weeks post-op. He didn't even have concerns about me tattooing my arm if I were so inclined. He said women regularly get nipple tattoos after surgery, which are perfectly safe.

So I had an artist friend draw up this amazing sketch for me based on a pile of random ideas I threw at her:

As I wrote back in November when I was first thinking about it,
"I already have vines up each arm and now I can have them join in some wonderfully delicate display on my chest. The only grieving I did before losing my breasts was when I'd think about losing my butterfly tattoo. I got it decades ago when I was trying to wean my son from breastfeeding. He was already three and showed no signs of giving it up willingly, so I was working on getting him through longer and longer periods without. But the little monkey would sneak into my room at night to nurse while I slept dead to the world! I tried wearing a bodysuit to bed, but he was able to get around anything this side of a suit of armour. So I got the tattoo to mark the transformation from my breasts being purely functional to being beautiful again, and, most importantly, to make sure I'd wake up from the pain for the first few days and stop my little snuggler in the act. It worked! And then it became a memento of that precious time of my life with my little ones. 
When I was waiting to go into the O.R., my kids asked if there was some way we could keep that bit of skin, and we made some pretty sick jokes involving pressing the butterfly in a book even though there are much better ways to save tattoos. But with the surgeon being pretty old-fashioned about aesthetics to begin with, I suggested they could ask him. I had too much else on my mind. And it can always be re-done among the vines."
So I made sure that butterfly looked the same as the original and was in the exact same place. And it was being done by the same tattoo artist who did the first one twenty years ago!

And then, the day before I had the first tattoo appointment booked (it would likely take 2-3 sessions each a month apart to do the whole thing), I finally got in to see the lymphedema specialist I've been waiting to see since May. Both surgeons and my drainage massage nurse had zero concerns about me getting a chest tattoo. But when I asked about it just once more, this occupational therapist said, "Hmmm....". I have no idea the hierarchy of knowledge here, so I wasn't sure if that "Hmmm" trumped all the other "No problem"s. I asked for clarification and she said something along the lines of, "If you want it enough, then you're going to do it." As in, I suppose, I can't stop you. But is it, 'I can't stop you, and it'll likely be okay', or 'I can't stop you, but I think you're an idiot'?? She wouldn't clarify further except to say that others before me have done it, and, here's the tricky part, they're not sure if it had any effect on their lymphedema.


One thing I DID get clarification on, that I was completely unaware of before, is that it's not just my left arm that needs meticulous cleaning, vigilant protection, and help draining, but the chest wall on the left side. That area formerly ALSO drained into my armpit. So while I've been crazy careful avoiding scratches on my arm and blisters on my hand, I've let my cats sleep on my chest knowing full well that if they get startled, they'll likely impale me in their hasty retreat. It would be really nice to have learned all this in one go! But she reminded me that there's no issue with getting a cut as long as it doesn't lead to an infection, which is why they focus so much on keeping clean.

I've never had an infection from a tattoo. I always heal really quickly from them. The studio I go to is absolutely immaculate, set up like a hospital with paper and plastic lining the bed and all the equipment, and the artist changes gloves regularly. So it should be okay, right??

Here's the real problem - maybe with everything. It takes me a while to process anything a doctor-type says. I don't know why, but I'm always a bit stunned when I get new information. So I left her office with just a little twinge of doubt about the tattoo scheduled for the next day.

I sucked it up and forged on ahead. At first, I suggested that we do the top part of both sides in the first session, so it looks even in tank top, but then I told him I was nervous about the left side. So he, wisely, just did the right side - with the butterfly. I've never been nervous about a tattoo before, and I actually started shaking once he got into it, but I've read that that's not an uncommon reaction at all - it was just really uncommon for me. It also hurt like a son-of-a-bitch! It was mainly the edge of the sternum and the bit on the rib cage that hurt, on areas not affected by the surgery, so I don't think the surgery had anything to do with the pain and shaking - except to freak me out about it. And it looks great!

But then, after I got home from that, I started to panic a bit. And that always leads me to googling like a manic. The tattoo didn't cross the line into the left side of the chest at all, but my arm felt weird. Well, weirder. I still haven't found a new normal to get used to since the nerves are regrowing all the time and could be for the next two years. I wondered if trauma to a different part of the body could affect it, or if it's all in my head. This recent NYTimes article didn't help assuage my fears:
"Tattoos are decorative, often metaphoric, sometimes regrettable, but always injurious. To create a tattoo, the artist punctures the skin with dye-filled needles at a rate of up to 3,000 times per minute. The dye is injected into the skin’s dermal layer, which is also where most sweat glands are. The body recognizes these injections as abnormal. They have slightly damaged the tissue and left behind a foreign substance, the ink. So the immune system gears up, sending a variety of cells to the site of the inking. Some cells carry off tiny amounts of the ink, primarily to the lymph nodes, where it dissipates. Other immune cells merge with the remaining ink, so that both become long-term residents of that portion of the skin. Still other cells initiate an inflammatory response, helping the injured tissue to mend, which it usually does within a few weeks."
This is just a few months after an article celebrating women who tattoo after mastectomy. Of course I found site after site that said nobody in their right mind should get a tattoo if they have lymphedema in that area!! I don't have lymph nodes to dissipate any ink on the left side. Except, for some reason, everyone's okay with a nipple tattoo. On this guy's "Dos and Don'ts" page, he's very clear: "No piercing or tattoos on the arm, back or chest," but then in the comments he says,

I don't understand how a chest tattoo can be a problem, but not if it's of a nipple, specifically. What does the design have to do with the risk?? What's the difference between a butterfly and a nipple? I can only assume it's the same issue that my first surgeon had: an obsession with making women look like women at any cost. Sure getting more surgery to get implants will increase lymphedema issues, but they still pushed it at me. And nipples are no different. By all means, do everything possible to avoid getting a mosquito bite, but don't worry about getting a huge incision and several subsequent surgeries. That's totally messed up!!      

Anyway, regardless the safety and cleanliness of the tattoo - certainly relative to a cat scratch - I decided to forgo symmetry and, for the next session, have the tattoo extend up and down a bit to take away from the idea of a bikini top using the dragonfly and foliage from the left side of the original design. Then we'll never cross into the left side and none of the work should have any affect on the lymphedema. I see both my drainage person and the occupational therapist again before that appointment, so I still have lots of time to reconsider and fret about it all.

I'll post pictures here once my son gets around to sending them to me from his camera, but I'm very happy with the results so far. I almost feel pretty again!


The butterfly just peeks out of my tank tops.
And undressed...
Only the near side is a tattoo - the other side is the stencil he puts on before he tattoos. He put it on the entire chest, then just focused on one side. I plan to get more colour - cornflower blue in the flowers and a muted green in the foliage. But then, instead of doing the left side, taking it out of the chest area further upwards to meet with the vine on my shoulder and downwards somehow. I'll have to figure that out yet.

He avoided the scar at this point, but said he could go over it in another year once it's totally flattened. But that blob of puckering skin at the outer edge is courtesy of a surgeon so convinced that of course I'll get recon work that he left a little behind for the plastic surgeon to work with. What a bugger!

And this is what it would look like if I don't chicken out and/or come to my senses (depending on the perspective) and avoid the left chest wall.

From the blog of another tattooing survivor with lymphedema:
The tattoo process is less invasive, less costly and far less disruptive to my livelihood than the multiple surgeries I am allowed if I change my mind....This new bit of ink is a refuge. To others, my chest tat provides a conversational and physical cover; for me, the piece offers mental asylum when I catch an unintentional reflection in shiny metal, computer screens, glass or whatever. It is a way I keep the life-full, empowering thoughts at the surface and keep the loathing, mournful thoughts at bay. I remind myself I had the drive and commitment to see something to its ultimate end. A method of making me feel proud of who and what I am and what I have had to invest in myself to get me physically, spiritually and mentally from diagnosis through recovery to today. 
So, there's that.


hello haha narf said...

i love the tattoo!! you wear it well.
with love,
an internet stranger

Marie Snyder said...

@hello haha narf - Thanks internet stranger!

Autumn said...

I am curious....did you go with the bikini top or stick to the right side? I recently had a lumpectomy and had the after thought of getting a tattoo that said no B/P or needles on the I dont have to wear a medical bracelet all the time. Been doing some research on tattoos and lymphnode removal.

I do like you tattoo and concept and agree with the statement if a nipple is ok, why not your butterfly. It's about what makes you feel good.

Marie Snyder said...

I just did the right side. After reading how taxing it is on the lymph system, I didn't want to chance it. It will never be finished. I do wish I had done it all before the lymph node removal though! Good luck with whatever you decide!