Nurse Tattoo Artist: Insurance Has to Cover Your Nipple Tattoo After Mastectomy

One in eight women will be diagnosed with breast cancer in their lifetime. So likely you know someone, maybe it's yourself, maybe it's a family member, or maybe just someone that you work with. But if you do have breast cancer, likely you will go through chemo, surgery. It's an entire fight. I'm excited today to sit down with my friend here, Krissy Dykhouse here in Brandon, the owner of Rise Skin Studio.

And what she does is she helps in that final step when you really want to feel whole again, feel like yourself. She helps with the process of nipple and areola tattooing. So again, she's here in Brandon with Rise Skin Studio. She's also a registered nurse. So we're going to talk a little bit about her journey from nursing into tattooing for breast cancer survivors.

All right, let's get into it. We're going to talk a little bit about what this looks like, how it feels, and how you can get in touch with Krissy. Let's dive in. Welcome to Dialed In Health. I'm Melissa Goodwin. Every episode, we bring in the people who actually do this work, providers, practitioners, the experts who see clients and patients every day. We ask the questions you'd ask if you were sitting across from them so you can find the right people, make better decisions, and feel confident about what's out there.

I'm super excited to chat with you here today to learn more about this. Thanks for having me on the show. So you also have another certification. Tell me what the certification is that you have to do this work. So I went to Texas to train with a paramedical tattoo instructor. We did a course, and then we did a live model day to tattoo with her to get the full experience and what that looks like for the patient from the start to the end and meeting in the plastic surgeon's office and performing that procedure.

So tell me, you're a registered nurse. You started out in nursing. Tell us a little bit about your journey from nursing to doing this areola tattoo work. The long story I will spare you from, but the short version is that COVID changed a lot of things for a lot of people in the medical field. And I just, it got me thinking about a lot of things, life with a lot of loss and death and things. And I was approaching age 40 and just thinking, maybe I need to be doing something different.

I ran into someone who teaches cosmetic tattooing and I thought I could do that for fun on the side. I love makeup and cosmetology and art. And so I trained to do that on the side. And then that opened up this whole wide world and algorithm of paramedical tattooing. So every video on social media, everything was this type of scar restoration and areola tattooing. So I thought this is what I want to do. And then I flew to Texas to get trained and started just trying to connect with plastic surgeons, nurses that I previously worked with that could connect me with the right people and started getting patients referred to me.

And that's the short version. I felt like I finally clicked into a place of utilizing my nursing career, but also the artistic side of me, I could still see patients. All these worlds collided into one beautiful career option. Amazing. Well, when you say cosmetic tattooing, that's like your eyebrows and makeup and things. And what you do is another step beyond that. Is that right? Yep. So what I did previously would be considered cosmetic. And then now I have gone into, some people like to call it cosmetic, but it's not at all. It's more of a medical procedure and a medical necessity in my opinion.

So it's also a little bit personal for you too. Tell us about the personal story that drew you into this work. Yes. Well, when I was about 10, my dad had colon cancer. They removed three fourths of his colon, thought they got it all. He did chemo, then it metastasized to his liver and he died four years later when he was 44 and I was 14. And I had always wanted to be a part of a community or group that got excited to support each other. And to be honest, a lot of people die from liver cancer.

And so this was a community that I am blessed to be a part of that I fell into as a provider, but really it has healed me in ways that I get to be a part of a cancer community where they're all cheering each other on and they're excited for each other. And to get to be a part of that without having a personal breast cancer experience, but having experienced loss from cancer has been a big gift for me. So tell us when someone comes through your doors, what are the things that they're most scared about or concerned about?

I would tell them that it's just the most personal decision that they could ever make. And it's not for anyone else to decide on. And that's the beautiful part of it. A lot of people will say, do I really need this? Yes, you deserve to feel whole again. Cancer didn't steal your nipples and a part of you that made you feel beautiful and feminine. It has to be for you and for nobody else, which is a very intimate decision. A lot of times they have questions on what could happen infection wise. A lot of them are pretty traumatized just based on what has happened previously.

It almost seems like they always end up needing some sort of repair or they get lymphedema or some sort of complication, whether small or big. And it's nobody's fault, it just happens. It's a very difficult area to work with and pending where the cancer is. And sometimes they try to save the nipple and that can't be saved. And so they're a little bit hesitant to have one more thing done. So what does that process from start to finish look like for someone who says, okay, I think I'm going to give it a try? How long does it take? How many visits?

Great questions. I always tell them they have to wait at least six months post last surgery. They have to get an okay from their plastic surgeon. That's the main thing. I don't care how long it's been. If you call me and it's been six months, I'm still going to have you call your plastic surgeon and say, they need to okay it. They know exactly what happened from start to finish with those surgeries and what complications did arise. And if this patient is ready for this, that's step number one. Then we set up a phone call for a consult. You'll come to my studio in person or Zoom. I have done out of state patients.

They come then for their first appointment. That takes about two hours. I always set aside a lot of time for paperwork. And then we spend quite a bit of time mapping them out, picking colors together, and just talking through the process. The tattooing itself doesn't take too terribly long, probably about 20 minutes to half an hour. Depending on the condition of the skin and scarring, sometimes it's a little more difficult to get that pigment to stick into the tissue just because it's not perfectly healthy skin.

I always include a second appointment in the initial fee. That is done six to eight weeks after that. And then I always tell them after that, if there's a third appointment needed, please get ahold of me. I'm not going to charge you for it. I just want to make sure you're happy with your results. Because that skin is traumatized, it can take extra time. When we're tattooing it, we can't over harass the skin because then it basically just rejects the pigment. So I always like to do micro appointments, is what I call them. We get as much ink and pigment into the skin as we can and then let you heal. I'd say 80 percent are probably pretty satisfied after two appointments.

This is going to be a weird question, but there's all different kinds of nipples. Do you choose from a booklet? I can show them pictures if they want. I've had several bring in pictures of their own. Either the physicians have taken a picture prior to surgery or it's a picture that they just had at home. And so I can absolutely mimic anything that they want. If they have no idea, then I tell them, this is your gift to yourself. You get to choose whatever you want. I have tons of pigment swatches and pictures in my portfolio. Another little fun detail is the little dots on the nipple that make it look really realistic. I've also had people put little names into their nipples, for someone that they love. So it can be anything you want it to be.

So what do you call that final step of the reconstruction? Is there a name for it? I would just say the grand finale. There's no medical term, just the nipple tattooing. And you mentioned making it look realistic. Is it like a 3D sort of rendering? Yeah, very much so. In fact, I love to show people pictures if they're interested. It looks very realistic, which is exactly what the patient deserves.

So I would imagine with any tattoo, people are always worried about the pain. Do you get a lot of nervousness around pain? Yes, and I do a lot of first time tattoos. Because a lot of them are women ages 60 something to 80 something. And they've never had a tattoo before. So it is nerve wracking for them. I always reassure them that most of the time, all those nerves have been cut through. There's not a lot of feeling there. And if you do feel too much, then I can use a numbing agent on the surface of the skin. And that eliminates 95 percent of pain.

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So what's the difference between going to someone like you versus just going to a tattoo shop? You could go to a tattoo shop. And I have a lot of friends in the tattoo industry. There's nothing against them. We all just have specialties. So I would say I offer that as my specialty. And so I've dedicated my trade to that. The other piece is the feeling of the space that I wanted to create. I didn't want it to feel like a hospital and I didn't want it to feel like a tattoo shop, because a lot of these older women have never set foot in a tattoo shop. And so I want them to feel comfortable.

One of my 80 year old patients said she did it in the basement of a tattoo shop. It was like in this little private room, but you walk through the tattoo shop and that's the only space they could offer that was private. They've been through too much to not have an experience in the space as well. So for me, that's especially important, besides specializing in it. And on the insurance side, you mentioned it is often covered by insurance. Can you speak to that? That is a loaded process. I always tell them from the beginning to call their insurance company, act like they know exactly what they're talking about.

The Women's Health and Cancer Rights Act of 1998 is a federal law that requires any insurance providers who pay for a mastectomy, they have to also pay for reconstruction, anything to create symmetry. If they have one side done and not the other, then insurance is required to pay for making that side look like the other side. It's been four years and quite a battle. And I didn't know it would be another one of my life's missions to get insurance to cover it, but they have to be willing to fight for it. I have a lot of patients that just say, I don't want to deal with it. It's 500 dollars. I'll just pay for it. Well, that just lets insurance off the hook.

So backing up to that first phone call, I have them call and just say, I want to get this done. I was referred by my plastic surgeon. What do you need for me to get reimbursed for this? They'll always say things like it's not covered. So then it starts the process of probably 20 hours on the phone for each patient to just talk to different people to try to get them to give me the required information and documents. They'll always try to find loopholes to say we aren't going to cover it, or a surgeon has to do it, which leads to another point. I've corrected many surgeons' works. They're great surgeons, but not great tattoo artists.

I will get this process smooth over where a patient doesn't even have to battle through. If you have a mastectomy, then you get to pick someone who's specialized in this service and it's supposed to be covered under the federal law. I have this whole portfolio, documented patient phone calls and claim denials, because I am ready to take it to the next step. I'm sad for the patients who are just tired. They don't want to fight. And so then they just want to pay for it. I don't want to take their money. I want to take money from the insurance companies that they've paid thousands into their premiums.

So for the women that choose to go flat, are there options for them too? Yes. Right now I am in a non traditional apprenticeship for traditional tattooing. Because I do want to be able to offer my patients artistic tattooing as well. Primarily that idea came about because I want to be able to offer patients non traditional nipple tattooing. If they want floral or some other design over that skin, it enhances that area without having anything there. It allows you to still feel feminine without having the pain of the implant and all of that process. We could do nipples on a flat surface too. But most of the time when I talk with people who don't do implants, they do some sort of design to cover the scarring.

So tell me a little bit about scars beyond breast cancer, like a tummy tuck, or a C section. Is that other places that you can tattoo over? Me personally, I did train, but then I wanted to specialize. I felt more drawn into the nipple tattooing. I have amazing resources locally for people to get scar repair and color correction. And so I do refer them out if they want something like that done, because that's a whole other ball game to specialize in. But there's options for people if that's what they're interested in.

So what would you want a woman going into surgery to know? Just that there will be an ending. It's very exciting. I always share that I feel spoiled to be a part of the grand finale and just the emotions that come with it. And to witness them feel like, oh my gosh, I feel like myself. It's a part of their story. Rise Skin Studio came from all these quotes that kept coming to me on repeat of still I rise, and the sun always rises. I get to be a part of the ending and lead them into the next exciting chapter.

So what is the inner transformation that you see when people come in and when they're leaving? I think it takes a little bit for them to really process it. They'll look at their nipples and they're always excited. But it's down the road when I talk to them and they've had it completed for a while. It's like, wow, I didn't know the difference that it really would make, when I'm looking in the mirror. It's not even like they're looking at their nipple. It's just seeing myself as a whole person in the mirror. I walked out one time and saw one of my patients give her husband a big hug out in the parking lot. It's healing for everyone involved who's close to the patient.

I have a few myth busters. Getting tattooed, especially in a sensitive area, must be really painful. Absolutely not usually, because they don't have a lot of feeling in that area. And if they do, then we can use a numbing agent and problem solved. Any tattoo artist can do work like this. Maybe. We all have specialties and portfolios. You want to know someone has spent a lot of time on this and can do a really good job. How many do you think you've done? Got to be close to a hundred over four years.

Regular tattoos fade. Do these fade as well? They do. Same amount of time typically. It varies based on the person. But I always tell them I'm here forever as a resource. If they fade really fast, then we'll just go back over them again. Are there any other conditions outside of breast cancer where somebody might need a tattoo like this? If someone had some sort of breast surgery and lost their nipple or had some nipple necrosis or different kind of traumatic scarring, I could do a good job making it look more like a natural breast. And if you choose to go flat, then tattooing is not an option. Very much false. I love to do florals and artistic cover ups on a flat chest, or we could do nipples too.

What is something that you would want even those who don't have breast cancer to know about the work that you do? I think that until you are personally hit with this or someone close to you is, you never really fully understand the impact that this makes. Someone they know at some point is going to be affected. Just to have a part of you taken away, and then to say that's just cosmetic, or that you don't really need it, that it's not that big of a deal. Anyone that goes through breast cancer deserves to feel like themselves again and feel whole. And I do think it's a bigger deal than people realize.

Well, thank you so much for the work that you do and for being such a fierce advocate for women on this journey. How do people find you if they want to learn more, or maybe it's a physician who wants to refer some patients? I would start at my website, which is riseskinstudio.com. Tons of resources there. And then there's also a way to email me and get my work number that you could also call or text. Perfect. We'll put links to all of those in the show notes. Or if you're watching on YouTube, click on the description and we'll have links to her website and all her contact information there. Thanks so much.

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