Micro pigmentation is the deposition of pigment into the most superficial skin layer using an array of tiny needles. For breast cancer survivors who have undergone breast reconstruction, creating a realistic three-dimensional areola complex and nipple is nothing short of a miracle. Colors can be mixed to achieve the most natural look for you, while incorporating shading to create the illusion of nipple protrusion and a life-like texture. Other aesthetic issues can also be addressed to help visually achieve better symmetry, balance and a consistent shape, size and color.

Skin discoloration and irregularities caused by scarring can also be addressed through scar camouflage and scar revision therapy.

Permanent micro pigmentation can also be applied to correct cosmetic imperfections as well such as small, discolored or too lightly colored areolas.

WHAT CAN I EXPECT?

More than one procedure is usually required to achieve the best results. Most clients can anticipate two appointments where the healed procedure can be evaluated at least 4 weeks after the initial procedure for any necessary touch-ups. The cost for the areola micro pigmentation services I provide—listed on the scheduling page—include TWO sessions. Any additional sessions will be billed separately.

All permanent micro pigmentation procedures will fade over time and touch-ups/maintenance may be necessary. This time frame will vary based on the area pigmented, sun exposure, pigment color, the individual’s skin qualities (i.e. scar tissue, radiated tissue, transplanted tissue, etc.), as well as other factors.

The process used to pigment the skin is not a one-step process. Soft tints of color (pigment) are implanted into the skin one layer at a time over multiple visits, with minimum of a one month period between each visit. Scars, thin skin, grafts and other irregularities can affect how the pigment heals into the skin. For this reason, re-pigmentation and color re-creation often requires multiple visits to simulate natural skin tones which will not always be a perfect match, this due to the fact that natural skin tones vary when the skin is cold or warm, tanned or untanned, or whether your circulation is good or poor. The implanted pigment is affected by ever changing tones of the epidermis.

DOES IT HURT?

While there may be some discomfort, a topical anesthetic will be applied to the area before the procedure which can be helpful in easing some sensation of pain. If you feel anxiety about the procedure and the potential discomfort, you should discuss with your physician the option of applying a prescription-strength topical lidocaine prior to the procedure. Your physical would need to write you that prescription. The disclosure of these and all other medications is required.

IS IT SAFE?

My clients’ safety, as well as my own, are the most important factors in all that I do. All instruments, tubes, needles and supplies are single-use, individually wrapped, sterile and disposable. All pigments and supplies used during your procedure are discarded afterward. I adhere strictly to the OSHA guidelines for sanitization and sterilization in a medical environment. I maintain current biohazard training and certification on blood-borne pathogens and infection control through Biologix Solutions.

WHAT HAPPENS AFTER THE PROCEDURE?

There may be swelling and redness of the skin, which will subside within 1-4 days dependent on lifestyle. In some cases bruising can occur. One can resume normal activities immediately following the procedure, however using cosmetics, prolonged exposure to water, excessive perspiration and exposure to the sun should be limited for up to two weeks following the procedure.

Immediately after the procedure the enhancement can be 30 to 50% darker than the desired result and can take between 4-10 days to lighten. The true color will be visible 1 month after each application, and color may vary according to skin tones, skin type, age and conditions. Some skins accept color more readily than others and no guarantee of an exact effect or color can be given.

Because non-toxic pigments are used during the procedure, micro pigmentation may fade over the course of 1-3 years. Even though the color may fade, some pigment may remain in the skin indefinitely and may leave a light residue of color.

It’s important to note that there are few effective methods for pigment removal. Laser removal has proven successful, however this is a process.

Your doctor should be informed of your micro pigmentation procedure(s) if you require a MRI scan within a 3 month period of receiving the procedure.

WHAT COULD EFFECT MY RESULTS?

The result of the procedure is determined by the following:

• Medication

• Skin characteristics – i.e. dry/oily/sun-damaged

• Natural skin undertones

• Alcohol intake and smoking

• A compromised immune system

• Poor diet

• Post procedure care treatment

All pre-procedure and post-procedure instructions, as provided and explained, should be followed. Infection and possible scarring can occur if one does not adhere to said instructions.

Patients always want to know if areola micro pigmentation is covered by insurance, and rightly so! This is a simple question with a complex answer. Stay with me…

Often times insurance companies will require a patient visit an “In-Network” provider for healthcare related services to qualify for any coverage. Which healthcare providers are considered “in-network” varies depending on that person’s individual policy and their insurance company. For a healthcare provider to be considered or qualify for in-network status, they must provide proof of having obtained professional state license. They are then issued a National Provider Identification number. Once the healthcare provider agrees to the coverage/payment terms the insurance company sets forth, they can become an in-network, or preferred provider.

This is where it gets convoluted in the state of Idaho. Unfortunately, the state of Idaho doesn’t offer professional state licensing for tattoo or esthetician professionals. Therefore a National Provider Identification number cannot be obtained and insurers will not allow a practitioner without one, like myself, to apply for in-network status. It is my experience that insurance companies treat this as a loophole for trying to avoid covering areola micro pigmentation procedures for their breast cancer survivor clients.

HOWEVER, according to the Women’s Health and Cancer Rights Act, insurance companies are legally obligated to cover breast reconstruction. Amputation/removal of your areoles are often a consequence of needing mastectomies. Therefore, areola restoration (micro pigmentation) IS part of the reconstruction process. That said, they must cover at least a portion of it. There is also no one in the state of Idaho licensed to do this work and therefore patients do not have the option of going with an in-network provider. And while some in-network plastic surgeons claim to provide areola tattoo, it is often NOT 3-dimensional life-like artistry. This is an important distinction!

Because I have been dealing with patients and insurers for the past fifteen years, I have had the opportunity to learn much about navigating claim submittal, and how to effectively and legally navigate the appeals process should one be initially denied coverage. It is my experience that how much coverage a patient is provided by their insurance depends on the individual’s specific policy, how much time and effort they are willing to invest in the process and the level of diligence they put forth. In short, the squeaky wheel gets the grease! I urge my patients to be firm and adamant, insisting their procedures be covered by their insurance! I know this is difficult, especially nearing the end of a very long fight for your life. Arguing with insurance is surely the last thing you want to do. This is precisely the reason I have put significant effort into providing my patients detailed, step-by-step instructions on how to submit their procedure claims for a successful outcome.

After the initial procedure (there are two), my patients are provided multiple forms of documentation for their claim submittal. This includes a detailed document on how to submit their initial claim, submitting subsequent appeals for coverage should they be denied, draft letters, and other critical pieces of information to include in their correspondence with insurance and various other government agencies—all of which determine coverage benefits. This is of tremendous value to my patients.

If you are beginning this journey, please visit cancer.org to familiarize yourself with your lawful rights as a survivor according to the Women’s Health and Cancer Rights Act.

I love when people that have been through hell walk out of the flames carrying buckets of water for those still consumed by the fire.

- Stephanie Sparkles

It was my own journey through breast cancer and reconstruction, which was done by Dr. Dinu Mistry, that led me to micro pigmentation. Nearing the end of my reconstruction, I came to realize that there was no one certified in the Boise area offering mastectomy patients who have undergone reconstruction quality and realistic “3-D” areola micro pigmentation. Of all the options available, micro pigmentation offers the most realistic results, is the least invasive non-surgical option and has no down-time. I knew the survivors in the Treasure Valley area needed and deserved to have the best options available to them, and I knew that with over 20 years experience as an artist and designer, I could provde this service. Since then, I have become certified as an Areola Specialist with the American Academy of Micro Pigmentation and have provided this service to create life-like, three-dimensional areolas for over 500 mastectomy patients.

Being able to offer this service to breast cancer survivors in a private medical setting is a huge part of why I’ve chosen to offer my services in a practitioner’s office. When I was at the end of my reconstruction journey, the last thing I wanted to do was deal with more insurance, or pay from already empty pockets for a service that, as a survivor, I believe should be covered by insurance and included as part of breast cancer reconstruction. Putting the onus on the patient to facilitate payment by insurance shouldn’t be, but often is, an obstacle to pursuing the last part of reconstruction.

Helping survivors finish their reconstruction without the stress of insurance hassles and being able to do this in a private medical setting is necessary and important to me. Helping patients feel beautiful and complete again, gives me more joy than I could ever express. Partnering with skilled plastic surgeons allows me to be a part of a highly talented and caring team, while allowing their breast cancer patients to finish their reconstructive process beautifully and easily.