Unveiling beauty: Insight into being tattooed postmastectomy

Abstract

Background

It could be argued that mastectomy tattoos are being considered by some women in contemporary society as an alternative to breast reconstruction.

Aim

To gain insight into the experience of “being” tattooed where breast(s) once occupied space, six women with mastectomy tattoos were interviewed.

Methodology

The teachings of Gadamer's philosophical hermeneutics were engaged to better understand what it means “to be” tattooed postmastectomy.

Results and Discussion

Discoveries include feeling sad and damaged postmastectomy, embodying the tattoo as a novel representation of self for women living without breast(s), and reclaiming power, control, and confidence in a way that is symbolically meaningful.

Conclusion

Health care providers working with women diagnosed with breast cancer are invited to learn from women with mastectomy tattoos and to consider expanding discourse about care to include options beyond breast reconstruction.

1. AN INVITATION

The idea of a mastectomy tattoo first introduced itself to me a few months following the removal of my breast as part of treatment for breast cancer. As I searched for alternatives to breast reconstruction, I did not know specifically what I was looking for but knew there had to be something. Something to help me overcome feelings of sadness when I looked at myself in the mirror; to ease my self‐consciousness during intimacy; to alleviate the daily reminder and remedy the loss I experienced; something to replace the breast that cancer took from me, and the scar left as a placeholder.

Initial web‐based searches presented various options for reconstructing breasts however the images of mastectomized bodies with chest tattoos displayed on Personal Ink's (p.ink) website captured my attention. I could see from the tattooed chest images that scar coverage as possible and the designs were quite beautiful. This was my invitation; the call to begin cultivating an understanding about what it means “to be” tattooed following a mastectomy.

2. STUDY AIMS AND DESIGN

The aim of this study was to develop a greater understanding about what it means “to be” tattooed postmastectomy. The term “to be” is ontological and used here to express being tattooed opposed to having a tattoo (as an object). The research question that guided the inquiry was phenomenological in nature and asked, “What are the lived experiences of being tattooed where breast(s) once occupied space?” To help make meaning of this phenomenon, six women with mastectomy tattoos volunteered to share their experiences through conversation with the researcher. The teachings of Gadamer's philosophical hermeneutics ¹ were engaged to draw closer to the phenomenon and acquire greater understanding.

3. MASTECTOMY AND THE IMPLICATIONS

In Canada, an estimated 27,400 women were diagnosed with breast cancer in 2020. ² Data reported by the Canadian Partnership Against Cancer (CPAC) revealed 10,000 mastectomies were performed between 2014 and 2016 in Canada, ³ however, mastectomy rates over the last ten years have varied across provinces with interprovincial differences from 25.3% to 68.3%. ⁴ Experiences of women following a mastectomy have been studied extensively, capturing both short and long‐term effects.

3.1. Factors impacting decision making and implications of choice

To help understand factors involved in decision making about whether to have breast‐conserving surgery (BCS) or a mastectomy, Gu et al. ⁵ conducted a qualitative study, interviewing women in the Canadian province of Saskatchewan diagnosed with breast cancer. Through thematic analysis, the researchers identified factors that motivated women to have a mastectomy versus BCS and included worrying about cancer reoccurrence, tumor size, the consequences of BCS treatment, such as requiring radiation, and the possibility of additional surgeries. ⁵ Another Canadian study conducted in Ontario and guided by grounded theory methodology identify how factors for undergoing a mastectomy were underpinned by fear of reoccurrence and death, suggesting a more radical decision to remove the entire breast affected by disease would avert reoccurrence and prolong life. ⁶

Experiences of women following a mastectomy have been studied extensively, capturing both short and long‐term effects. Many of the outcomes are psychosocial in nature and include decreased quality of life, ⁷ concerns about body image such as being self‐conscious about scaring, ⁸ sexual well‐being, ⁹ depression, ¹⁰ struggles with identity, and being stigmatized. ¹¹ , ¹² Physical symptoms have also been reported such as women experiencing diminished sensations ¹³ , ¹⁴ and challenges with upper arm mobility on the affected side(s). ¹⁴ , ¹⁵

Despite adverse outcomes, the research reviewed above suggests more women are undergoing mastectomy following a breast cancer diagnosis in some Canadian provinces and while immediate breast reconstruction rates are increasing, they remain low. Alternative body projects such as tattooing, have been taken up by some women without breast(s) as a practice of self‐care and can be considered part of an expanded “tattoo renaissance.” ¹⁶ Although the prevalence of mastectomy tattoos is not known, we can look to the efforts made through the not‐for‐profit organization  personal ink (P.ink) to learn that hundreds of women across Canada and the United States have been recipients of free chest tattoos since 2013, as part of P.ink Day campaign. This campaign towards tattooing, replacing breast(s) with a form of artistry is fueled by P.ink's mission, “to empowering women to reclaim their bodies after mastectomies.” ¹⁷

4. MASTECTOMY TATTOOS

Very little is known about what it is like to be tattooed postmastectomy, despite some women choosing this unconventional body project as an alternative to reconstruction. ¹⁸ , ¹⁹ Despite a lack of research, relevant literature suggests motivations for women being inked postmastectomy include regaining one's identity, improving body image, sense of beauty, and heightening feelings of control. ¹⁹ , ²⁰ Diagnostic procedures such as ultrasounds, mammograms, biopsies, magnetic resonance imaging (MRI), computed tomography (CT), and lengthy treatments which may include chemotherapy, surgery, and radiation leave lasting effects which can lead to feelings of powerlessness and for some women, distorted images of self. ²¹ Although anecdotal, Allen suggests that through art (tattoos), women can regain their sense of “beauty and agency.” ²⁰

Unfortunately absent, are research studies generating knowledge about the experiences of women being tattooed postmastectomy. To help fill this gap, a hermeneutic study was conducted to interpret the lived experiences of women who live tattooed where breasts once occupied space.

5. RECRUITING PARTICIPANTTS

Tattoo artists in Canada and the United States specializing in mastectomy tattoos were contacted via email and provided information about the study. Artists were asked to post the recruitment flyer in their studio and distribute the flyer to women known to have amastectomy tattoo. Inclusion criteria included being English‐speaking women, older than 18 years of age, having undergone a unilateral or bilateral mastectomy without surgical reconstruction, and have a mastectomy tattoo.

5.1. Participants

Six women consented to participate in the study. All participants identified as Caucasian, five were Canadian and one American. Participants were between 48 and 65 years of age, and five were married at the time of the interview. Five participants had bilateral mastectomies and one had a single breast removed. The length of time participants had been living with a mastectomy tattoo ranged from one month to three years. All participants consented to participate in the study and have their tattoo photographed and used in professional presentations and academic journals for the purpose of sharing knowledge and deepening understanding about being tattooed postmastectomy.

5.2. Ethical considerations

An application to the human research ethics board at the University of Victoria was approved based on the Tri‐council policy requirements for the ethical conduct for research involving humans (Protocol number 18‐200). The collection and use of photographs were approved by the research ethics board. Pseudonyms were assigned to protect identity.

5.3. Data collection

Data were collected through an audio‐taped conversation with participants lasting 60–120 min and photographs of participants' chest tattoos were provided by the participant or taken by the researcher. With the aim of the study to develop greater understanding and meaning about being tattooed postmastectomy, questions were scaffolded so participants could move from sharing experiences of being diagnosed with cancer, how they made treatment decisions, how they experienced their body following the removal of their breast(s), why they considered tattooing as an alternative option to traditional breast reconstruction, and their experiences of being tattooed. Audio recordings were later transcribed verbatim and analyzed.

6. METHODOLOGY

As an interpretive phenomenological approach rooted in philosophical inquiry, Gadamerian hermeneutics situate human understanding in language, proposing that it is in and through language that the ontology of things in themselves is revealed. ¹ The spirit of Gadamer's hermeneutic teachings allows qualitative researchers interested in human experiences in the lifeworld an invitation; a call to understand phenomena not well understood and the opportunity to render free the ontology of phenomena, in a practical way. ¹ Expressed differently, when we lack knowledge, understanding, or meaning about a lived human experience, engaging in a conversation with individuals who have had an experience of the experience can reveal meaning and help us to understand.

Important to Gadamer was how one comes to understand, and his teachings suggest when there is a problem understanding what something means, the phenomenon can be worked out in what is known as the hermeneutic circle. ¹ The hermeneutic circle is an ontological space where the primordial “things in themselves” is discovered through a dialectic of question and answer; questioning how parts of an experience related to the whole and the whole relate to the parts. ¹ An interpreter can enter the hermeneutic circle at any point to engage in a genuine conversation with a phenomenon or experience they do not understand, provided they do so with authenticity and an openness to consider other meanings outside of their present horizon. One's present horizon is described by Gadamer as “the range of vision that includes everything that can be seen from a particular vantage point.” ¹ (p. 313) Language is used as the medium to translate to the interpreter, that which has been unveiled about the phenomenon of interest which Gadamer suggests is a form of authentic play that emerges when one is in a deep, genuine conversation with text. ¹

6.1. Locating self: Gadamer's practical wisdoms for interpretive discoveries

I centered myself before engaging with textual transcripts created from having conversations with participants, reminding myself that discovering the ontology of what it is to be tattooed postmastectomy comes from knowing the right questions to ask. Gadamer ¹ proposed that meaning can be concealed, so I acknowledged the importance of having an authentic dialogue with language found in participants' text and was mindful that what is brought to the surface will be understood from my present horizon, which contains presuppositions, biases, and prejudices acquired through living. I took steps to reflectively capture my thoughts and feelings through journaling and acknowledged my experiences of living in the world without a breast are part of what constitutes my present horizon.

I reminded myself to contemplate what might be at play when in conversation with the language used by participants and the importance of entering the hermeneutic circle with an openness to learn from participants' experiences. As I entered the hermeneutic circle, I reflected on Gadamer's teachings which encourage me to allow language to be the opening for dialogue, and to consider what the text is trying to reveal about the phenomenon in question. ¹ I deliberated on language used by participants to describe their experiences and reflected on metaphors, rhetoric, intonations, moments of silence, and other linguistic elements to reveal meaning. I considered the etymology of words, questioned interplays that existed between the experiences of being tattooed postmastectomy (parts) and how they related to the various aspects of participants lives (whole). I questioned how the whole experience of cancer, undergoing a mastectomy, not having reconstruction, living in the world with one or no breasts and scarring contributed to the parts‐ the experience of being tattooed postmastectomy. As I settled into the fluid movement that is part of authentic dialogue, I was reminded of the fusion that can occur between what is revealed about the phenomenon through language and my historically effected consciousness. ¹ I remained open to the possibilities of what the experiences of others may afford; the opportunity for fusion and for my horizon to be expanded.

7. INTERPRETIVE DISCOVERIES

7.1. Feeling sad and damaged

One cannot begin to understand what it is like to be tattooed postmastectomy without considering what it is like to live without breast(s). During conversation, many participants expressed deep dissatisfaction when they first saw their chest following a mastectomy. The pain of having cancer and losing their breast(s) was heightened by the appearance of the scar, and chest wall deformities. One participant, referred to here as Pat shared her experience of seeing her mastectomy site for the first time. “I wouldn't have felt so shocked and upset if it had been smooth like it should have been… I hadn't realized how horrible it really looked… I feel my eyes welling up again thinking about it.”

Participants were disembodied as the scars and disfigurement prevented recognition of self (Figure 1). Contemplating the statement from another participant, “We shouldn't be sad when we look at ourselves” created an opportunity to develop greater understanding of what it means to live in the world without breast(s). Exploring language used by participants to learn how self is conceptualized following a mastectomy revealed insecurities related to identity, sexuality, femininity, and beauty. Participants who visualized their chest with scars and deformity instead of breast(s) were left looking at a shattered distorted image of self. Through the following account their disembodiment and the complexity of living in the world as a woman without breast(s) is conveyed. “When I would look in the mirror and see the scars, like coming out of the shower or something… it would totally take me back to, oh yes, I'm damaged, I've had cancer…and it was really a struggle to try to not see myself in a negative way. It was just every time I saw it, I was like oh yeah that is what I look like now…I don't feel like I look like I'm full of scars…I feel like me but when I see myself then it's a reminder that oh no, you're not really you.”

Figure 1.

Author's mastectomy scar and chest wall deformity [Color figure can be viewed at wileyonlinelibrary.com]

Drawing upon the meaning of the word ‘damaged’, offered insight into the concept of the postmastectomized self. As a noun, damaged means loss or harm that comes from injury to person or character. ²² The loss that comes from losing a part of the body that is a signifier for being a woman in contemporary society was met by participants with insecurity when perceived as no longer beautiful, desirable, or feminine. The appearance of self with scars and deformity instead of breast(s) became a daily reminder of having had cancer and reinforced the power and control women lost to disease.

Thoughts and feelings of difference were reified when participants became the object of the humanities' gaze. Stares sent a message of being abject and contributed to fears of no longer being a woman with societal attributes aligned with having breasts such as being beautiful, sexual, or feminine. These afflictions chipped away at their identity evoking feelings of powerlessness and the need of protection. A poignant remark expressed by a participant whose pseudonym is Lizzie supports these feelings of not blending in [with other women in society] when she didn't have what she calls her “shirt fillers.” Manufactured breast forms or prosthetics initially became part of a standardized defence used to disguise absent breast(s) and alter the optics for symmetry, despite participants reporting the expense and lack of comfort not being worth the cost. Many of the women chose to make their own lightly padded breast forms to give the illusion of having breast(s) when outside the home.

The vulnerabilities tied to being a woman in contemporary society surfaced in other more intimate areas of participants' lives as well. An atmosphere of melancholy was created when women shared experiences of being intimate, feeling insecure when their partner looked or touched them. Lizzie, also commented on this vulnerable state, by revealing that she was never comfortable being seen by her husband without wearing a camisole during intimacy. Mastectomy scars represented loss, most notably in the daily reminder of having had cancer. Inspiring however was the will of participants to look for ways to reclaim their power and hope for something different.

8. RECLAIMING SELF: TAKING BACK POWER AND CONTROL

As the conversation continued, women began sharing experiences that shifted away from what was lost to what had been reclaimed through bodily inscription of tattoos. One participant, whose pseudonym is Vivian reflected on a time in her life when she was downhearted but how the thought of being tattooed created a liveliness to help her take back her power.

“I was off the beaten path…I mean I just was kind of not caring and then you know once I had the pursuit to get the tattoo and I saw there was somebody out there close to me that actually does this, then I kept pursuing it. I got excited, I started to get excited about something again…it put me back on you know my life's path… I'm back on…the tattoo definitely got me back on track” [and] it's totally me and it really did empower me. I like to use that word because that's how I felt because it was my choice. It was my choice to have it, it was my choice when she [tattoo artist] showed me the design to say either yay it or nay it; it was my choice with the color, my choice with the design, my choice where it was…so to me, that gave me power.”

The word “pursuit” used here by Vivian helped expand understanding of the phenomenon of being tattooed as a woman situated in the world without breast(s). Pursue means to follow something or someone. ²³ There is a spirit of adventure in having a pursuit, of going after something without really knowing the outcomes. Gadamer discusses the concept of adventure by suggesting “an adventure lets life be felt as a whole, in its breadth and in its strength” … having the capacity to “remove the conditions and obligations of everyday life…venturing out into the uncertain.” ¹ (p. 63) Despite not knowing what the tattoo might offer, the pursuit for change, of wanting something different from how life was being experienced following cancer and a mastectomy created hope and excitement for participants. The adventure of getting a tattoo became an escape from what had become reality following cancer and created a space where excitement was felt instead of despair. The adventure started with many participants looking at pictures of mastectomy tattoos online. Visualizing the mastectomized chest adorned with a tattoo opened up possibilities for something different and the hope of reclaiming self ‐ albeit in an alternative way. Participants acknowledged the permanence of modifying the body with ink commenting on how the decision was not made lightly. They also expressed how much time was involved in contemplating the design so it would symbolize both what was meaningful and embody aspects of their identity. An air of enthusiasm was shared, and excitement heard in each participant's voice as they described with detail the meaning of their tattoo and how they collaborated with an experienced tattoo artist to create a unique tattoo. For example, a participant with a Keltic background whom I refer to as Anya, shared some of the planning leading up to getting her tattoo and how the tattoo makes her feel (Figure 2).

Figure 2.

Anya's symbolic tattoo in Gaelic [Color figure can be viewed at wileyonlinelibrary.com]

“I started with a saying in Gaelic…'what doesn't kill you makes you stronger'…so I was going to have that right over the scar…and then she ran with it (referring to the tattoo artist) and it turned into what it is‐‐ which is way more… and it is beautiful because she um has the whole outline, the Gaelic symbol for mother and then it says what doesn't kill you will make you stronger in bigger letters… I look at my tattoo and I'm like I love my tattoo…it's not the cancer…I am proud of it…like you know I survived cancer, did the surgery, and now I have this great tattoo.”

The thrill that is part of having an adventure continues to be experienced when parts of the tattoo are revealed. Participants expressed liking when some of their tattoo is exposed, creating an air of mystery that makes them feel sexy. With a playful spirit, Lizzie remarked “I love when a piece of my tattoo shows. It makes people go, “oh she has a tattoo under there” and it's a little bit of a mystery; it's like a teaser and I feel a little bit like a bad ass.” Lizzie was not the only participant to use the term “bad ass,” in fact most of the women used the trope during conversation to express the feeling of being tattooed.

Historically the term bad ass referred to “a bad or slightly frightening person,” ²⁴ someone “ready to cause or get into trouble.” ²⁵ In contemporary society, however, the term “doubles as an endorsement of a woman who is particularly strong” ²⁶ and admired by others. ²⁷ In this sense, calling someone or something “badass” is a compliment. The change in meaning of this word is interesting since historically individuals who had tattoos stereotypically were considered to live more on the margins of society, not conforming to societal norms by pushing its boundaries. ²⁸ I sensed this was how participants thought of themselves which would seem appropriate given that each participant refused the recommendation for breast reconstruction, opting for something more novel. Contemporary use of the term however was apparent when one of the participants explained how her kids reacted to her tattoo. They were proud of their mom, encouraging their friends to see it, saying, “you've got to see my mom's tattoo…and a couple of them said oh, that's bad ass.”

8.1. Transformation: Embodying the tattoo as a novel representation of self

Having the opportunity to spend time both conversing with women who have a mastectomy tattoo and immersing myself in the data has expanded my horizon about being tattooed postmastectomy. I have come to understand how mastectomy tattoos signify healing for these women who have lost their breast(s) to cancer and ultimately transform their perception of self, unveiling the beauty that resides within. There is a concept in human sciences called Bildung, a German word used to describe self‐formation or cultivation. ¹ Recognized here is the idea that human beings continually attempt to cultivate themselves, often through inner processes such as reflection. Although the word ‘cultivate' has different meanings, the intention of developing oneself or perhaps returning to what may be within one's nature is offered as a way to understand how tattoo inscription intersects with freedom to not conform to society's heteronormativity or mainstream discourses in breast cancer treatment options and promotes new capacities for developing self.

When participants reflected on their experiences of living without breast(s) and being tattooed, I began to understand how Bildung was at work in their lives. No longer were these women stunted by the effects of cancer but rather being tattooed was cultivating a self more aligned with a spirit of renewal. We can understand more intimately the cathartic power of ink through Vivian's testimony.

“Since I've got my tattoo, I look at myself in the mirror every time I get out of the shower (laughing). I have a smile on my face, ear to ear. It's beautiful and it's me and its now…. I'm very happy with it, it's just ah, it's just that it did change me, it really changed how I felt about myself and how I looked at myself… I'm a 65‐year‐old woman that got a chest tattoo after a mastectomy and I think it's beautiful.”

There seems to be something very powerful about being tattooed postmastectomy, potentially signifying empowerment, transformation, and healing by creating a new reality for and of self. Modifying the mastectomy scar through inscription shifted the focus from having had cancer, experiencing loss and disfigurement, to having affection for, control over, and honoring the journey that transpired. For one participant referred to here as Lily, part of the journey was discovering that she had a story for which she professed, “I can tell it, or I can wear it.” Lily took great pride in describing her tattoo in detail, capturing the symbolisms reflected in the design and why being tattooed is important to her (Figure 3).

“I wanted the peacock feather, and it comes down into a quill, because I am a writer and that quill is over top of an open book, with the writing “My Story is Eternal”. Underneath the book the quill is kind of dripping red ink and to me that was more like blood and the writing is in that red color which is very different than the colors of the feather or the rest of the tattoo. I was making a statement, to remind myself that I have a story, [um] and I'm a writer so you know my story is eternal, not just because of my faith in God but because I am a writer and pieces of it will be left.”

Figure 3.

Lily's ‘visual story' tattoo [Color figure can be viewed at wileyonlinelibrary.com]

It required having something run as deep as having cancer to be the impetus for change in how participants perceived themselves postmastectomy. Tattooing became the medium, where the power of agency and commitment led to changes in both how participants experienced their world and how they perceived self. Being tattooed evoked emotions of pride, strength, and affection, and symbolized beauty, femininity, and sexuality in novel ways. As a tattooed person postmastectomy, participants viewed themselves as unique rather than flawed and saw their beauty embodied through art. One participant, whose pseudonym is Karen, described this uniqueness helping us to understand transformation in this context (Figure 4).

Figure 4.

Karen's cherry blossom and hummingbird tattoo [Color figure can be viewed at wileyonlinelibrary.com]

“I can't explain to you really what, how my mental state of my breast cancer changed from having the tattoo. I was totally against tattoo's…but this is different because it was a choice instead of getting reconstruction. It was giving me something back that I lost in a way that was personally just my decision…it changed me so I could be happy with my body. I have something really really special and really beautiful that other women don't have… and when I look at myself in the mirror, I have beautiful artwork that I look at every day and am thankful that I have it.”

9. DISCUSSION

Previous studies exploring psychosocial effects following mastectomy align with the key discoveries of this study. To explain, the feelings of shock, disembodiment, and inferences made about being less feminine, sexual, and beautiful have also been reported by other researchers who have explored women's experiences following the loss of their breast(s). ¹² , ²⁹ , ³⁰ However, in this current study it is participants' enduring distress experienced when looking at oneself postmastectomy that differs from what has been found elsewhere. The feelings of sadness and being damaged postmastectomy are foregrounded in this study and provide sharp relief with the experience of being tattooed. Several participants described anguish when looking at themselves in the mirror, seeing their mastectomy scar and chest wall deformity, and the persistent sadness when coming out of the shower. These experiences support the findings captured by Freysteinson et al., in their study exploring the experiences of viewing self in the mirror after a mastectomy. ²⁹ Freysteinson and colleagues found some women experienced emotions such as shock, sadness, disgust, and self‐revulsion when they looked in the mirror following a mastectomy but noted over time it became easier to view themselves. ²⁹ Despite the similarities in how women experienced visualizing their body in a mirror, participants in this study did not experience alleviation over time. Specifically, it was the unending negative feelings these women experienced when mirroring, that led them to look for a way to transform their appearance.

Scholars have noted, that for some, being diagnosed and treated for cancer can be traumatic. ³¹ , ³² , ³³ According to Huang, tattoos can be considered part of self‐care, ³⁴ capable of healing places deeply damaged by trauma and contribute to reclaiming one's identity. For participants in this study, the incessant reminder of having had cancer was amplified when they looked at themselves. The surgical removal of one's breast(s) with the resultant scar and deformity was traumatic leaving participants feeling despondent. Interestingly, however, was their enthusiasm to consider another way to exist, albeit one that has not always been socially acceptable. For these women, choosing to be inscribed with indelible ink filled the space where breasts once existed and contributed to regaining control over their body and the power lost to cancer.

Despite a mastectomy tattoo being situated in a more private versus public space, participants expressed liking when some of the ink was revealed. This created an opportunity to narrate the significance of their tattoo, explaining the symbolism, and how being tattooed in an area that once caused strife was now a canvas for meaningful art. Having the chance to re‐write one's story or inscribe parts of that story on the body is powerful and reflects the strength these women had to reclaim self, taking back power and control through their own efforts. These findings support and strengthen current understanding about motivations for tattooing that include beautification, ³⁵ identity formation, ³⁶ , ³⁷ , ³⁸ regaining control following a personal trauma, ³¹ , ³⁸ , ³⁹ , ⁴⁰ and the healing conveyed by some who use their tattoos to tell a story. ³⁹ , ⁴¹ , ⁴²

Key discoveries from this study contribute to the small yet growing body of knowledge about the role of tattoos in health and healing. Discoveries that surfaced from my conversations with women who chose to be tattooed postmastectomy introduce readers to this option and add to our understanding of why some women postmastectomy tattoo. Being tattooed enriched the lives of participants by embodying the tattoo as a novel representation of self. Women in this study no longer saw themselves as damaged, lacking beauty, femininity, or sexual appeal, but rather as unique, special, and fortunate, to adorn a beautiful piece of art that signifies beauty in an alternative way. The process of tattoo inscription and embodying symbolic art where breasts once existed contributed to a transformation experienced as healing from the trauma caused by having cancer.

10. LIMITATIONS

It is important to acknowledge the limitations in this study. Foremost is the lack of diversity in the voices who shared experiences about what it means to be tattooed postmastectomy. Critical to developing a greater understanding about the phenomenon of being tattooed where breast(s) once existed would be hearing the experiences of black women, women of color, and women from culturally diverse groups. With this study being the first to explore women's lived experiences of being tattooed postmastectomy, it is an entry point to understanding this phenomenon, and future studies would continue the discovery and expand horizons.

11. IMPLICATIONS FOR NURSING

This study offers three key interpretive discoveries that can provide nurses and other healthcare providers insights into their care. Understanding how women may feel sad and damaged following surgery opens avenues for empathetic questioning and therapeutic support. Sharing the research experiences of women who found the process of designing and being tattooed transformational and empowering may introduce new options for exploration that include esthetics and beauty. Experiences such as those shared by participants in the current study can expand the horizons of healthcare providers, opening space to understand and practice differently. Being tattooed unveiled the beauty embodied by women who chose to cultivate self in an alternative way and nurses are encouraged to share these experiences with those searching for options beyond breast reconstruction. Patient‐centered care includes conceding to the idea that individuals may want to ‘dance to their own rhythm as declared in Lizzie's unique tattoo (Figure 5).

Figure 5.

Lizzie's unique mastectomy tattoo [Color figure can be viewed at wileyonlinelibrary.com]

12. CONCLUSION

To conclude, I share a poem rooted in participants' stories that conveys some of what was interpretively discovered. My intention is to allow readers alternative ways of understanding and to conclude with an opportunity to expand our horizons. That is, to broaden our understanding of women's experiences postmastectomy and the power of beauty unveiled through being tattooed where breasts once occupied space.

13.

The cathartic power of ink

Ever present, the fear of not surviving this disease,

radical decisions to exist,

so afraid of dying, the realization that fragments of your mind, body, soul, and spirit have been lost to the pain of what remains, brokenness.

But is this not a form of dying, when life as you knew it, is no longer?

Losing hope for happiness, fearful of never finding your way back to living,

but then you marvel, introduced to what may be a form of salvation.

An innovative idea, one that excites, offers adventure, creativity, beauty, and power.

Rich in symbolism and a way to return to living, with pride, passion, and joy,

You take hold, propelled by the cathartic power of ink.

Jong VR. Unveiling beauty: insight into being tattooed postmastectomy. Nurs Forum. 2022;57:536‐544. 10.1111/nuf.12714

DATA AVAILABILITY STATEMENT

Data available on request from the author.