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Feature 10 May 16

Nipple Tattooing Slow to Catch on in Serbia

Cosmetic nipple tattooing is becoming a common treatment for mastectomy patients elsewhere, but Serbian breast-cancer survivors are reluctant to undergo an additional procedure.

Ivana Nikolic
Grbic pledges to continue tattooing nipples free of charge. Photo: BIRN

A painter by education and a permanent make-up artist by profession, Belgrade’s Sanja Grbic has offered expert nippletattooing to breast-cancer survivors for the past two years.

Sympathetic to theproblems of women who undergo mastectomies, Grbic is one of a handful of Serbian artisans trained to create artificial nipples with tattoo ink - and possibly the only one doing it for free.

It all started during her university studies, Grbic says, when a friend dated a woman who had undergone a mastectomy.

“He told me she was very uncomfortable with her appearance,” Grbic remembers. “She hadn’t had reconstructive surgery and she simply didn’t want him to see her naked.”

That was when inspiration hit. “In that moment I realized how big the problem is for women who have mastectomies,” Grbic says. “That’s when I understood the extent of their insecurities.”

But while therapeutic nippletattooing is a growing trend in Europe and North America, it is far from common in Serbia. Grbic says that in two years she has tattooed only five women – all acquaintances of friends. In true Serbian tradition, her practice is growing slowly by word of mouth. “I still haven’t had someone who has heard of me in some other way, ” she says.

Grbic believes women in Serbia are unwilling to have nipple images tattooed in place because they are reluctant to undergo another procedure as part of the grueling breast-cancer ordeal. Also, she says, they are sceptical because the procedure is rare and there are not many tattoo artists in Serbia who are trained to do it properly.

Besides, she adds, Serbia’s state health insurance does not cover the expense of cosmetic nipple tattoos – which is why she intends to continue performing the service at no charge to patients.

Jasmina Lukic is a representative of“Let’s Be Together,“ an association that supports women who have been diagnosed with cancer as well as those who have undergone treatment. She says women are aware of reconstructive nipple tattooing but that the procedure is “not as commercially exploited as abroad.“

“None of the women in our association have had the tattoo. That is very intimate and it is up to each and every woman to make such a decision,“ she told BIRN.

‘I will feel better’

“Jane” is a 40-year-old artist who agreed to speak to BIRN under condition of anonymity. She has only recently decided to have her nipples tattooed. After undergoing an eight course of treatment that has included a double mastectomy, a series of chemotherapies and plastic surgery, she will be ready for nipple tattoos in autumn.

“It was not hard to make such a decision,” she told BIRN.

“I think nippletattooing is a great thing because women can feel better – I will feel better – when they look into the mirror,” Jane says.

This breast-cancer survivorbelieves cosmetic nipple reconstruction is important for every woman who has had a mastectomy. For her, it is also the end of a long and painful road that started when she was diagnosed and told she would likely not survive.

A common malignancy

Breast cancer is the most common malignant tumour among women in Serbia. One in eight Serbian women will be diagnosed with breast cancer during their lifetimes.

According to the Belgrade-based Institute of Public Health of Serbia “Dr Milan Jovanovic Batut”, about 4,100 women are diagnosed with some form of malignant breast cancer in Serbia each year. About 1,600 die of it.

Due to these alarming statistics, Serbia’s Health Ministry launched a national programme for early detection of breast cancer and established the National Cancer Screening Office in 2012. The office performs breast-cancer screening throughout Serbia at no cost.

According to the office’s data, in the first cycle a total of 78,600 women were examined, 290 of whom were diagnosed with the disease. During the second cycle, in 2015, another 40,700 women were scanned, with another 201 being diagnosed with a breast cancer. The free programme is still on-going.

No one collects statistics regarding the number of women who have received mastectomies as part of their cancer treatment, nor the number who have subsequently undergone breast reconstruction – including nipples.

Special clients

It is not only patients who are sceptical about reconstructive nipple tattoos, Grbic says. She has also met with little success in her efforts to reach out to surgeons and private clinics.

“I wrote emails to private clinics, I called doctors who specialised in breast cancer. I asked if I could do the tattooing for free for their patients. But I got no response,” Grbic says.

While these institutions have not embraced tattooing, it is possible that their patients have undergone a more invasive form of nipple reconstruction: skin transplantation, either from the other nipple or from another part of the body.

Tattooing is also possible at some of the private clinics and is done by doctors themselves.

Whichever form of reconstruction a woman chooses, she must wait six to 12 months after surgery.

Grbic says that getting nipples back is of extreme importance for every woman who has gone through a breast-cancer nightmare. Patients tell her that nipples help them feel womanly again. They have a lot more self-confidence and they are not afraid of looking at their reflections in the mirror.

Working with breast-cancer survivors is very different from Grbic’s main job, permanent make-up. While women who opt for permanent make-up can be demanding, cancer survivors are a lot easier to work with.

“I have done all sorts of cosmetics things to women – but none of them are happier than the ones who have their nipples tattooed. It is incredible,”Grbic says.

“They are very helpful. They are not demanding. And at some point they usually start crying,” she says.

While she plans to expand her practice beyond Serbia’s borders, Grbic says she will continue making Serbia’s women happy free of charge. “Our women have no money for that,” she says. “I will never ever charge them.”

This article was published in BIRN's bi-weekly newspaper Belgrade Insight. Here is where to find a copy.



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