There were three tumors, all on the right breast. Once doctors confirmed they were cancerous, Kristyn Bova actually felt a little better: Not knowing was worse than having a diagnosis and a path forward. She didn't want to risk leaving any cancer behind, so she opted for a full, double mastectomy.
"The girls did their job," says Bova, who was 51 at the time, in early 2012. "I nursed three beautiful babies. They're no longer needed now. They tried to kill me, and it's time to go."
Bova said focusing on the good things she did have (a supportive family), and on the bad things she didn't (uncertainty about her diagnosis) helped her immensely during this period. The day before her mastectomy, she spoke on the phone with a close friend who'd recently been diagnosed with an aggressive form of brain cancer. She died while Bova was recovering from surgery, so two-and-a-half weeks post-op, Bova and her father drove from Sierra Vista to San Antonio, Texas, for the funeral.
"I was so lucky," she says. "I had these extra appendages that I could cut off and move on with life, but she couldn't get rid of her brain. That was so eye opening. If I'd ever thought, 'Poor me, poor me,' [I realized then], it's not 'Poor me.'"
Her reconstructive surgery was just a week after she got back from the service. She opted for a procedure called Deep Inferior Epigastric Artery Perforator, which involves taking fat from the abdomen and using it to reconstruct the breasts. (Bova had heard about the procedure years ago, on Oprah, and remembers thinking, "If I ever get breast cancer, that's what I'd want to do.")
The recovery was long and exhausting, but she was excited to have a new pair of breasts that looked and felt almost normal—not to mention that she had a chance to "donate" some of her abdominal fat to the cause. But there was still something not quite the same: She didn't have any nipples. Her surgeon asked her about her plans to do something about it during her follow-up appointments. For example, she could have her nipples reconstructed to make her breasts look more like "normal" breasts, and even have a tattoo artist add pigmentation and areolas.
"Every time I went in, he would say, 'What are we doing about nipples?'" Bova says. "I said, 'Nothing! I don't need them anymore. Nobody needs to know that I'm cold.'"
Like many people, Bova didn't spend a lot of time consciously thinking about her nipples before this. Like she said, they'd served their purpose, as far as she was concerned. But there's a wide body of research about how the reconstruction of nipples after mastectomies can lead to increased psychosocial wellbeing.
A 2016 study in the International Journal of Surgical Reconstruction, for example, found that the reconstruction of the nipple-areola complex (NAC) improves patients psychosocial and sexual wellbeing. Women reported feeling more confident, emotionally healthy, attractive and "of equal worth to other women." Other studies have even found that, after NAC reconstruction, many women even report higher satisfaction with the size, softness and sexual sensitivity of their reconstructed breasts as a whole—even though the addition of a nipple doesn't physically change any of these things.
Bova wasn't particularly interested in nipple reconstruction. Another surgery sounded like a hassle, and she'd heard that maintaining new "nipples" might even require further surgeries. Her surgeon gave her a pamphlet for a local permanent cosmetics artist named Elaine Pichet, who does work ranging from permanent makeup and eyebrow tattooing to paramedical work, such as camouflaging scars, repigmenting the scalp after hair loss, and nipple tattooing. While Pichet does tattoo pigment onto reconstructed nipples, she also creates hyperrealistic 3D nipple tattoos onto reconstructed breast mounds.
Bova looked at the pamphlet, and with continued encouragement from her doctor, reluctantly made an appointment with Pichet, who runs Artistic Touch, Inc. with her daughter. She sat down and looked through photos of work Pichet had done for other clients. She didn't need them, and she wasn't sure she wanted them, and her insurance didn't cover the procedure... but they looked good. After what she describes as a "bizarre tornado in the head," Bova eventually decided to go back to get new nipples tattooed. When she stood up to see Pichet's handiwork on her body, Bova gasped. Before, she jokes, she could have walked down Oracle Road topless and no one would have made a big deal out of it, because the mounds on her chest didn't look like breasts without nipples. Now, they did.
"What I found after they did the tattooing was that she gave me my privacy and my femininity back," Bova says. "It was very odd. It was not something I ever expected, but they became private again. They weren't just flaps of skin; they were breasts, and they looked like breasts. And even though they didn't have a 3D nipple attached to them, they were totally different than what I went in with."
It's not an uncommon reaction. Pichet, who has been tattooing for 23 years and doing realistic nipple tattoos for almost as long, has tattooed hundreds of nipples onto clients. She likes to share a story she heard at a breast cancer event one year. A woman who had gone through breast cancer and finished her mastectomies and reconstructions kept returning to her doctor, insisting that something was wrong. Her lab results were all healthy, but she was worried and depressed, so eventually she met with her plastic surgeon again. That's when they realized what the problem was: She hadn't gotten her areolas and nipples repigmented. That was what had been bothering her so much, without her even realizing it.
"It's very, very emotional," Pichet said. "That's what I've noticed with all the clients. It's kind of the last thing they do to bring back a little bit of the normalcy. It's never going to be the way it was, of course. But at least by doing this, it looks a little bit normal."
Pichet didn't start tattooing until she was 35, but she felt right away like she was meant to be doing it. When COVID-19 hit and they had to close up shop temporarily, she says she sat and stared at a wall for two days, totally unsure what to do. She's much happier now that she's back working in the office with her daughter, helping women feel beautiful. In fact, Bova has gone back to her a few times, for lip pigmentation, permanent eyeliner and a touchup of her nipples. Elaine's office was one of the very first places Bova visited once she began venturing back out into the world after the lockdown.
Lucky for Tucsonans, Pichet isn't the only tattoo artist in town who provides this service: Kari Cadenhead of Marigold Tattoo does nipple tattoos for cancer survivors, trans individuals post-top surgery and anyone else in need of a nipple tattoo. She's certified in the A.R.T. of Areola Restorative Tattooing, a style of 3D nipple tattooing which uses a specialized permanent ink. Cadenhead has been tattooing for 15 years (she also does traditional tattoos, stick-and-pokes, and scar coverups) and began A.R.T. tattooing in 2017.
Having a foundation in traditional tattooing meant she'd had lots of experience covering up scars and, of course, being careful with making permanent marks on people's bodies. But she learned quickly that A.R.T. was a technique all its own, due to factors ranging from tattooing on irradiated skin to the sheer emotions of the process.
"I don't want to say my average tattooing is not important or heavy, but, at the same time, the nipples tend to be an extremely emotional, personal process," Cadenhead says. "When you go through that, you're not taught that it's an amputation. Doctors don't consider it that, insurance doesn't consider it that. But, like, what if you cut your dang nose off? You would need a new nose, or you would want to look like you have a nose."
Cadenhead says some of her favorite pieces to do are corrections, for people who got nipple tattoos or scar covers from another tattoo artist who did a terrible job. The long road it took for her clients to get to her for a job well done makes the work extra rewarding.
She used to have her own studio in town, but it closed down due to the pandemic. While she does traditional tattooing at Church Ink Tattoo Parlor, she also works out of the Village Salon, in midtown, for clients who may not feel comfortable in a tattoo shop setting. She also offers her services on a sliding scale, depending on what clients can afford.
Cancer patients often survive not only cancer, but chemotherapy, radiation and surgeries that leave them feeling sick and exhausted. At the end of such a long, hard road—even if the road only involves one of those things—nipples might not seem like such a big deal. Indeed, nipples are not physically very big, so what business do they have taking up so much space in our psyches? Think about how a single cancer cell can metastasize across organs and limbs and lives, and you'll see how a cancer patient understands, perhaps better than anyone, how much room small things can take up in your head and your heart and your body.
2020 hasn't been kind to Bova, just like it hasn't been kind to anybody else. She lost her husband in February, and her mother later in the year. She's now living with her daughter in San Antonio. But she's finding the bright side, as usual, enjoying the extra time with her daughter and practicing gratitude. She wonders if her cancer would have been found so early if this all happened in the 1950s. She wonders if she'd still be here.
"I'm so grateful for all the advancements in medicine that mean I'm still here, and I'm only 60—I just turned 60 in February, and I've got a lot of stuff to do," she says. "I still feel like I'm in high school. I still have art I want to do and pieces I want to make and flowers I want to plant, and I want to be with my daughters as long as I can. I'm just profoundly grateful that I live now."