“I told my assistant very point blank, ‘Listen, most of these people are going to be really nice, but it’s a heavy subject. I get it.



“I told my assistant very point blank, ‘Listen, most of these people are going to be really nice, but it’s a heavy subject. I get it. If it’s too much for you, just say the word’,” says tattooer Amy Black (pictured below) from behind her desk. We chat in her Carytown studio – a warm and inviting space that functions as both tattoo shop and office.

This article was featured in the latest RVA Mag print magazine, RVA #20. You can check out the entire mag digitally here, or at any of these local spots while they last.

She’s explaining the nature of “contact calls” – precursors to an appointment. Black, who has been tattooing for over fifteen years, started doing what are called ‘post-mastectomy nipple and areola repigmentation,” aka nipple tattoos, about four years ago. “Contact calls are hard, because you get a list of five breast cancer survivors, and you’re supposed to call them and say, ‘Hi! I’m contacting you about your tattoo!’”

Black, who began the Pink Ink Fund in 2011 as a way to ensure this procedure was available to those who couldn’t afford it, says the mastectomy tattoos only account for around “one percent” of the work she does. “I couldn’t do [them] full time. It would just be too heavy, and extremely repetitive.” In fact, she’s had a very successful career outside of her work with breast cancer survivors. She’s won Style Weekly’s “Best Tattoo Artist” every year since 2011.

She’s been featured in BUST Magazine, has done Ted Talks, and has been a guest lecturer at the VMFA.

Although she’s also known for her nature-oriented and traditional tattooing, Black explains she can’t pigeon-hole herself when it comes to a particular style. “There’s not one single [style] I go back to, because that’s not how I stay motivated and energized,” she says. “I love traditional tattooing – don’t get me wrong. It’s the main core of everything I do. I just don’t publicize it… And you know, there might be three main things that I switch back and forth from, but I know for a fact that if I only did one style, it would not keep me motivated and re-inspired.”

So, is that kind of how you started with the repigmentation? Just wanting to expand?

No. I got a cold call, out of the blue, by a breast cancer survivor. And she was searching for a tattooer who could do something super-realistic, vs. what she was seeing done, which was more of a really standard recoloring. But she just had an implant – a flat implant; she didn’t have a reconstructed nipple. So she needed a 3D look.

How do you do that – the 3D Look?!

Using all the stuff I learned in college, whenever I was doing figurative drawing and painting. And of course it’s not oil paint, and it’s not drawing, and it’s a totally different canvas–but the main, basic ethics and rules of how to create light and shadow and use perspective.

Black explains that she became fascinated with human anatomy while in art school. During her foundation years at college, she found herself gravitating toward and enjoying her required anatomy classes. “It had so much to do with actually being able to draw the human form better. And that’s by learning the structure underneath [the skin]; the musculature, the bone – the skeletal structure,” she says. “I ended up loving it. Oh my god it was so rad. All of that was just a natural love, but was it going to make me a living? No, probably not.”

But now you’re doing it on the ultimate canvas!

I know! It’s so strange! So that’s how it culminated into doing this.

Was the first repigmentation you did scary?

No… no. Because at that point in time, I’d been tattooing for ten years, so I knew the skin. I knew how that was going to react… I’d also researched enough to figure out where the implant was lying underneath the tissue. I studied it, so I was like, “Yeah, this should be ok.”

The only big challenge is that regardless of whether you’re doing a nipple tattoo or if you’re doing a traditional diamond or something, you’re expected to, or at least you should hope, that you’re able to please that client right there, instantaneously.

But that’s how the whole mastectomy tattoo came about. It just fell into my lap. The lady didn’t know me. We had no contact with each other before she just contacted me out of the blue.

Did you ask her how she’d heard of you?

She had independently been cold calling shops around town and was hoping to find a woman – and she didn’t have to, but she was going to feel more comfortable. Her second question was “Can you do this?” And I was like. “Yeah.” But it wasn’t just like, “Sure, I guess.” It was like, “Yeah I can totally do this! I feel really confident that I can do this!”

How many years ago was this?

I think it’s about four years ago now.

Do you know, roughly, how many you’ve done since then?

I don’t really keep count. Hundreds?

Something that attracts me to this story so much is that breasts are such an integral part of gender identity. And we’re constantly bombarded with imagery of what they’re supposed to look like by the media. I can’t imagine losing mine. What I’m trying to ask is, is it an emotional experience? For you, interacting with this kind of client – how does it differ from doing a traditional tattoo? In my mind I’m like, “Oh my god, I’d be so affected!” But you do this a lot. I guess it’s probably similar to the way doctors approach it.

I think if you’re going to handle it the healthiest way possible, you are going to bring that to the table. And not everybody is, and I’m not a robot. I care about [each person], and I want to let them know that I care–that they’re not just another number coming in and out. It’s a big deal for them. I honor that, and I let them know that I’m aware of that. I think a lot of people, when they ask these kind of “emotional” questions, they’re trying to figure out how it would feel for them. And from that perspective, it is, like, mindblowing.

Like, you set up the rest of your year knowing you’re going to talk to at least one breast cancer survivor a month. Every month for the rest of… as long as you do this. If you want to try to put some context on it. But do I get caught up in that? No. That’s not the point. I’m here to do a service as best as I can for these people, and be as centered and focused and grounded for them as I can.

How long does it take?

For just a standard nipple and areola – for the 3D – it tends to take 30 to 45 minutes a side. For me. So that can’t be said for all people that do this.

Black started the Pink Ink Fund as a “gut reaction to having started the service.” She wanted women to know that, regardless of health insurance status, they could receive this service.

Black wanted women to be able to breathe a sigh of relief–after all the chemotherapy, all the hardship and loss, they’d be able to have this one thing taken care of.

Nipple reconstructive surgery was considered an optional procedure by insurance companies until 1998, when the Women’s Health and Cancer Rights Act (WHCRA) clearly defined a woman’s rights post-mastectomy. Repigmentation was and still is considered by many insurance companies to be an elective procedure. As Black explains, the nipple tattoo “was supposed to be a part of [the WHCRA], but it’s changed a lot.”

Black tells the story of a woman – a buddy of hers – who was in her late twenties and living week-to-week at her table waiting job. Her entire family was BRCA (BReast Cancer susceptibility gene) positive, and they, as well as her doctors, had been pressuring her to get a double mastectomy and hysterectomy–all before she was 35. So not only was this woman terrified of the prospect of getting cancer, she also had to think about whether or not she wanted to get married and have children. With everything weighing on her on these deep levels, she was also thinking, “How am I going to look if I get this surgery?” She sent Black a message thanking her for the fund, because at the end of the day, she knew the money was there if she needed it.

“That’s why I made it,” says Black, as she points her finger on her desk. “For her. Because there’s probably thousands of her… People who aren’t sure how they’re going to pay for this one last part.”

With the recent rise in social media, breast cancer survivors have been able to share empowering post-op photos of themselves, possibly contributing to a rise in less traditional reconstruction procedures.

I read about women who have had double mastectomies, and there’s at least one photo on your site of a woman who chose not to get the reconstruction, who chose, rather than reconstruction and traditional repigmentation, to get a vine tattooed across her chest.

It’s definitely more uncommon. But I think what’s great is that – if you keep tabs on it at all – we’re gonna see a rise in that. There’s a movement of people who are more open about that, sharing… empowering photos [of themselves], empowering stories to let women know, “Oh look, there’s another woman who went through what I did. She didn’t get reconstructon, and she looks beautiful and says she feels great.” So that’s something new right now.

It totally goes back to the societal pressure to look a certain way, and shattering those norms. Using yourself as a platform to do that – that’s hard. Especially with something like your breasts.

At this age, you’re not married. But if you feel like you need to have a relationship, how are you going to broach that when you’re dating? Like, oh by the way!

Yeah, like, “I don’t have these things that are really important to a lot of people who are attracted to women.”

Yeah, and “I also have a pretty decent amount of scarring instead.”

Do you have any really touching stories that stand out?

[There was] this one lady who had brought her husband in, and the appointment was fine, everything was cool, jovial; [we were] having a good time, and everybody was in a pretty good mood. She was getting ready to walk out the door, and I just saw them stop and kind of look at each other… I was trying to, you know, not stare at them, and give them their time, even though they’re like four feet away from me [laughs].

Anyway, [her husband reached into his sleeve] and pulled out this bracelet that was like, tan. They both looked at each other and I was just like, ‘OK?’ Then I figured it out – it was [a] pink [silicon Livestrong-style bracelet] – he had been wearing it since they started.

That’s the kind of thing I was talking about – I don’t think I’d be able to handle it. But that’s an awesome moment.

It was just so sweet to me! I mean, the bracelet was like [points to my offwhite notebook page] that color by the time she was done. And then he finally took it off! I was like, “Holy shit, guys, I can’t believe you just did that in front of me.” He could’ve taken it off whenever she had done her last reconstructive surgery – those are way more dangerous and way more invasive than what I’m doing. I’m really just on top there for a half an hour or so.

But it really is – and this is a terrible euphemism – the icing on the cake.

No no, they say it, too – you’re not the only one. I get it. I always make sure that everybody knows, I’m super aware; I do not try to make it seem that I’m some type of big deal just because I’m adding that nipple. The hard work is being done by the medical staff that are getting her though the cancer. I get it, though. I realize that’s the end of their journey.

It really is though. Although I’m speaking from no experience at all, to me, it’s like… you’re you again. In a certain way.

Yeah, women get that.

In her TEDx Talk, “The Power of a Two Inch Circle,” Black explains the concept of a “drive-by,” which was introduced to her by her clients. For breast cancer survivors, she explains, “the drive-by is that moment that you walk past the mirror every morning on your way to the shower, and you have to see your scars.” In her TEDx Talk, Black says her clients tell her the nipple and areola repigmentation helps quiet the constant reminders of cancer.



I always thought it might be an interesting social experiment to somehow figure out how to – I don’t know how you’d do it. But think about if you just took some flesh-colored silicone thing.

Like pasties, almost?

Yeah! And forcefully made yourself wear that all the time, for at least a week. Just to see how that felt. And not just [that] – it’s like, totally different breast shapes and sizes that they’re dealing with. The fact that at the beginning, that psychological impact of being told you have cancer is like getting hit with shell shock. And thinking of [all the treatments you may need] – that’s the heavy stuff. Then you get into the reconstruction portion, which is also a whole ‘nother ball of wax.

The placement of what you’re doing – do you try to make it even to the other breast?

That question changes per client.

Whatever they want, kind of?

Yep. And that’s where I’ll bring that other level of service. First of all, it’s giving them the power of choice back–which is so critical to healing. They’re not given a choice at all until that point. They do get certain ones–they don’t have to get implants, but if they want them they have to get either gel or saline. That is something they can control [only] to a finite point. But the first option I give them is do you want to retain your original look?

And are some people like, ‘no?’

Yeah. Some people are so jazzed on their new ones! They’re like, “I hated my old ones; I did not like the color of my nipples, so let’s do something totally new.” And some people are like, “I loved my old ones, so if we could at least try to get the color back…”

How is it, generally, when people see the finished product?

I prep them as much as I can nowadays – just like, “Get ready, it’s going to be super bright the day of [the tattooing].” But most of it’s been great. Most people are very happy.

Amy Black’s studio is located in Carytown at 3125 West Cary St, keep up with her on Instagram here