For transgender and nonbinary people who have had top surgery, getting a nipple tattoo can be one of the last steps

Aedan Donovan hadn't been to the beach in years. Jesi Pick can finally comfortably take trash to the curb without a shirt on.

The two born-and-raised Minnesotans recently received top surgeries—gender-affirming procedures for the transgender and nonbinary community that involve reshaping breast tissue to feminize or masculinize the chest. The procedure typically includes the partial or complete removal of breast tissue, and the reshaping or removal of both nipples.

A year after their top surgeries, Pick and Donovan took another step. They received nipple reconstruction tattoos, a form of body art growing in popularity in the trans community over the past decade.

"It just gave me such a calming sense of acceptance and peace in my body," said Pick, who uses they/them pronouns.

Pick, like many trans tattoo clients, found additional acceptance and peace after going under the needle.

Nipple tattoos involve re-creating the image of a nipple and areola on a client's chest. There are options in terms of color, shape and size. Nipple reconstruction can also be done surgically via skin grafts, but many people who've had top surgery opt for a tattoo.

Tattoos have long been used by women who've undergone mastectomies to treat or prevent breast cancer. In recent years, they have grown in popularity for top surgery recipients.

Tattoo artist M Nijiya, who uses they/them pronouns, has been tattooing for 13 years and has made gender-affirming tattoos a focus of their work. Some clients seek 3D nipple tattoos, while others have asked the artist to highlight the scars on their chest with art that signifies the surgery's role in their gender affirmation journey.

Nijiya is the owner of Jackalope Tattoo, in the Powderhorn Park neighborhood of Minneapolis. It started in 2013 as an all-women's shop, but has evolved to feature a still-expanding 13-artist roster composed of trans, nonbinary and female artists.

Nijiya has received top surgery themself and said that understanding trans clients' experience makes the process easier.

"I've literally been through what they've been through," they said. "I've worked side by side with some of the surgeons in the area, so I know a lot more about what goes into getting top surgery and healing."

'Like you're in your true body'

Donovan, who uses he/they pronouns, originally received top surgery in 2022 and opted for a double mastectomy without having nipples surgically reattached. He did so knowing he'd get nipple reconstruction work done with Nijiya, who had tattooed Donovan years earlier.

The top surgery combined with Nijiya's affirming art lifted a weight off Donovan's shoulders.

"It's a level of elation that I don't think a lot of people can really understand who haven't gone through it," he said. "It's this level of not only confidence, but just really feeling like you're in your true body."

Often, the wait time for gender-affirming medical care can be months or years. The delay is excruciating for many trans or nonbinary people, given the mental health benefits that come with surgery.

The Harvard School of Public Health found that gender-affirming surgeries "were associated with a 42% reduction in psychological distress and a 44% reduction in suicidal ideation," compared with trans and nonbinary people who wanted but didn't receive surgery.

"We realize this could really solve a lot of the dysphoria that [we're] feeling," Pick said. "Once you realize that, and then you have to wait, it's so hard to experience that day to day."

Nijiya prioritizes getting top surgery clients in as soon as possible, often scheduling them after hours. Nijiya is seeing three to five trans clients each week, considerably more than when they started tattooing. Especially in the past five to six years, there have been more appointments than ever, due to word of mouth in the Twin Cities.

The increase may also come as transgender health care access has expanded in the past decade. The Human Rights Campaign studied 1,028 American businesses in 2019 and found that 83% of them offer trans-inclusive health care benefits, up from just 9% in 2009.

'I would just rather blend in'

But still, there are obstacles to finding trans care. Anti-trans bills have been introduced in 45 states this year, and Nijiya says many trans clients are getting tattoos just to feel safe.

"People have contacted me recently," Nijiya said. "Since the new bills have been getting introduced, they're just saying, 'Hey, I was feeling good about my top surgery scars, and now I would just rather blend in [so] people might not clock me.' "

The tattoo industry has work to do on inclusivity, Nijiya said. Many of Jackalope's trans clients have traveled from out of state and even from out of the country to find a shop in which they feel safe.

Given that tattoo artists often start their careers as low-paid apprentices, Nijiya said the primarily white and male demographics in tattoo shops limit opportunities for artists from marginalized communities. It can also lead to uncomfortable experiences for non-male clients.

"Some people don't want to be tattooed by men, or maybe they've been victimized," said David Lane, author of "The Other End of the Needle: Continuity and Change Among Tattoo Workers," and associate professor at Illinois State University. "You're going to spend a lot of time in close quarters with somebody touching your body—you want to be comfortable with that person."

Lane is currently researching trauma-informed tattooing, which urges artists to recognize that tattooing is a shared experience and to be mindful of their clients' comfort.

Angel Ylitalo, a tattoo artist at Jackalope, said she immediately felt comfortable when she joined the shop two years ago.

"I didn't feel like I had to put on a persona," she said. "In shops I've been in previously where it's just these older white men bro-ing it up, I had to sit in the corner and kind of be quiet."

Ylitalo, who is Korean, says the majority of her clients are Asian and have said they feel more comfortable getting cultural art done by somebody who understands the context.

When it comes to nipple tattoos, the same can be said. As awkward and intimate as such a process can be, Pick said it was reassuring to know that Nijiya understood the trans experience.

Pick got their first tattoo from Nijiya more than 10 years ago, when the artist was just an apprentice. The design was an upside-down equilateral triangle, a symbol once used to identify gay prisoners in the Holocaust and later adopted as a universal symbol of LGBTQ pride.

As Pick watched Nijiya's reach expand in the years since, they knew they'd go to Jackalope to get nipple reconstruction done, and the experience lived up to all expectations.

"Immediately after getting the tattoo, it all just looked like it should be—like it always should be," they said. "It brought me so much peace."

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