Leaving a mark: Tattoos and breast health

Tattoos have been around for centuries. They've been used to reflect changes in life status, passage into adulthood, or induction into a group or society, like a gang or the military. Today, a tattoo is more like a fashion accessory or form of self-expression through art. For some women, a tattoo on their breast is an expression of femininity. For others, like those who have had an experience with breast cancer, tattoos are a way to cover scars or create a meaningful symbol of their experience.

A recent report by the Food and Drug Administration estimates that as many as 45 million Americans have tattoos. According to a Pew Research poll from 2010, 23 percent of Americans have a tattoo, and 32 percent of people ages 30 to 45 have at least one tattoo.

While tattoos may be more common than ever, there are risks to consider before getting "inked." Among them are the permanence of the art and the potential risks.
 
For starters, it's important to understand how a tattoo is made. A tattoo is a permanent mark or design that is made by inserting pigment through pricks into the top layer of the skin. One or more needles puncture the skin to insert the ink, which can result in a small amount of bleeding and mild to moderate pain.

Because the skin is breached, there are possible complications. 

• Skin infection. Bacteria on the skin can enter at the site of the tattoo and cause cellulitis, or skin infection.
• Allergic reaction from the dye. Red, yellow, green and blue dye can cause an itchy skin rash at the site of the tattoo.
• Granuloma or keloid formation. Sometimes bumps called granulomas form around tattoo ink. Tattooing also can lead to keloids—raised areas caused by an overgrowth of scar tissue.
• Bloodborne pathogens. If the equipment that is used to create the tattoo is contaminated with infected blood, you could contract blood borne diseases including tetanus and Hepatitis B or C.

When it comes to breast health specifically, women often ask if there are any special concerns with breast tattoos. In particular, they want to know if a breast tattoo affects the quality or interpretation of a mammogram. Typically, no.

Most tattoos on the breast will be undetected by a mammogram. But there are a few ways that breast tattoos can affect imaging: 

• Tattoos can lead to skin granulomas or keloids. Calcifications may form within the skin. Additional mammograms or ultrasound imaging may be required to confirm the abnormality is not within the underlying breast.
• Tattoo dye can be absorbed by the lymphatic system and accumulate in the lymph nodes of the axilla. This accumulation of dye can give the lymph node an abnormal appearance and lead to an unnecessary biopsy.
• Tattoos might cause swelling or burning in the affected areas during magnetic resonance imaging (MRI) exams.

Fortunately, these problems do not happen often. But if you have a breast tattoo and are concerned or have questions, talk to your doctor.