Snezana Matovic wore her nicest black jacket and an excited smile into a permanent makeup clinic in Manhasset. After all, it was a very special occasion, one she had waited more than five years for: the day she'd finally get her nipples back.
"Will it hurt? Will the tattoo hurt?" she asked, turning to face a thin woman wearing a baby-pink smock and medical mask. The woman was Olga Lucia. Born in Colombia, Lucia is a cosmetic tattoo artist who for the past 25 years has been helping Long Island breast cancer patients regain their old sense of self by tattooing areolas on their new breasts after reconstructive surgery.
"No, it won't," Lucia said.
"Well, I had my eyebrows tattooed and that hurt," Matovic retorted.
"That's only because you didn't have them tattooed by me," Olga Lucia said jokingly.
Matovic, who in 2013 was diagnosed with breast cancer after noticing a small patch of orange peel-textured skin on her right breast, said the cancer broke her threshold for pain.
"When all of that was said and done," she said, "the last thing I cared about were my nipples. I was too scared to go through a procedure of any type again. It felt more important then to just be alive."
That changed two years ago when Matovic met and married Peter Aber, 60, of Bay Shore, a man she describes as "so loving" and "100 percent understanding."
"But I only let him see my breasts once," she said. "It was hard because I, myself, didn't even like looking at them in the mirror. He said 'I don't care. I love you,' but he knew this was important to me."
Aber took it upon himself to call plastic surgeons to inquire about areola tattoos for Matovic, who had been using temporary nipple tattoos he found online.
"I had to put a new one on every three days," Matovic said. "I would shower, and they would fade."
Aber said many practices he called did not offer the tattooing; the ones that did charged thousands of dollars. Health insurance was not an option for the couple, he said, because "our health insurance did not fully cover it."
"We'd have to pay about $5,000 out of pocket," Matovic said.
Finally, Aber stumbled upon Olga Lucia's Permanent Cosmetics office online. He called and explained their situation, and Lucia told him she'd take care of it.
For six years now, every October Lucia has "taken care of it," by hosting a "Day of Beauty" for breast cancer survivors at her office, giving several complimentary areola tattoos and enlisting a professional makeup artist and a hair stylist who treat the patients to free services. Patients in need also receive complimentary wigs.
"This is my gift. This ability that I have, my art, my life, I have it all because God gave it to me. That's why I feel that it's so important for me to pay it forward and use my skill to help others," she said. "I started receiving so many calls from patients who needed this, they needed their areolas tattooed because they were walking around feeling incomplete, but for one reason or another, they just couldn't afford it. Their insurance didn't fully cover it or they were asked to meet a high deductible, and others were uninsured."
Traditional inks and specialized cosmetic pigments are used in the tattoos, which take about an hour per breast. Doctors suggest waiting about four months after surgery before being tattooed. Complications may include allergic reactions and infections, but experts said they are rare.
Lucia has done complimentary areola tattoos on more than 40 breast cancer patients on the Island.
Diane Rudolfsky, 61, who had a double mastectomy in June 2015, had been on Lucia's to-be-tattooed waiting list since last year.
"I was the first person here this morning. Her very first appointment of the day," said Rudolfsky, of Lynbrook, after being tattooed. "For such a long time, I didn't want to look at myself. But now, they look great! They look like breasts again!"
Rudolfsky said using insurance would have cost about $7,500. Her eyes lit up as she talked about Lucia: "I mean, thanks to her I feel like myself again."
Dr. Neil Tanna, a plastic surgeon with Northwell Health who specializes in breast reconstruction surgery and performs areola tattoos, said for patients who have had reconstructive surgery, nipple tattoos are life-changing.
"Studies have proven that restoring the breast mound and the nipple, restores the woman's sense of self. It's something that's often closely tied to her sense of femininity," said Tanna, who has been operating on breast cancer patients for the past seven years. "The psychological benefits of completing this process are immense ... It's an important part of the patient's overall recovery."
The same rings true for male breast cancer patients, said Scott Stone, a former East Meadow resident who lives in Scottsdale, Arizona. Stone had a right mastectomy in 1993 and got a nipple tattoo sometime after.
"If you think about it, men spend a lot more time than women without our shirts on," said Stone, 61. "We're walking around outside the house without a shirt on when it's hot, if we go swimming to the beach or pool, we're bare-chested there, too, so it definitely takes a toll on your confidence and yes, I was self-conscious to be out in public with only one nipple, but that changed when I got the tattoo."
It changed something for Matovic, too. As she laid in Lucia's office with her breasts exposed, the cold tattoo machine pressed against her skin with its whirring sounds filling the silences in the room, she finally let herself cry — not because of the tattoo. "I never cry," she said in between laughs.
"I don't know why I'm crying, but as I'm laying here I'm reliving everything I've been through in the last few years. I never had time to cry," she said. "But now, with this, I feel like it's all finally over. Thinking about everything, it makes me sad, but right now I'm also so, so, grateful and happy."
Long Beach survivor transformed by breast cancer advocacy
When AnneMarie Ciccarella heard her doctor mouth the words "breast cancer," she immediately froze.
"It was like being sucked underwater," she said. "I could hardly breathe. I couldn't speak."
Now, the 61-year-old Long Beach resident, diagnosed with the disease in 2006 after a routine checkup and who had a double mastectomy shortly thereafter, travels around the country speaking to large crowds at medical conferences, passionately advocating for breast cancer research.
"That's why I often refer to myself as the 'accidental advocate,' " Ciccarella said with a laugh.
"I never pictured myself standing in front of so many people and being able to share my story with them," she said. "I never thought I'd be so openly talking about my experience with breast cancer or talking about the science behind the treatments. It's been a dauntingly wild ride but through it, I've been able to find my voice and now, I'm trying to use it to help other people."
At first, Ciccarella, whose treatment included eight rounds of chemotherapy and removal of both of her ovaries, said she felt "unqualified."
But in October 2012, she was transformed.
Her close friend Lori Marx-Rubiner, a fierce advocate who died from breast cancer last year, nominated Ciccarella to be part of Project LEAD, a science course for breast cancer advocates run by the National Board for Certified Counselors, based in North Carolina.
She was selected to be part of the program as a panelist and patient reviewer. And quickly realized, she said, "Research is where it was at, in terms of where I wanted to focus."
Since then, Ciccarella has attended countless breast cancer research-related symposiums — both as a student and an educator, listening and speaking.
She's participated in the Alamo Breast Cancer Foundation's Patient Advocate Program and the American Cancer Association for Cancer Research's Scientist Survivor Program, and was a presenter at the AACR's annual meeting held in Washington, D.C., in 2017.
There, Ciccarella presented a project — not in the advocacy section set aside for patients, but instead, in a section of the conference destined for scientific work.
The project was the University of Southern California's CancerBase, a data-sharing platform created to help patients exchange treatment information with others with similar diagnoses.
"Crossing over from the patient advocacy section to the scientific realm, for me, was so validating because it was a testament of the value of the patient perspective," she said. "That patients are finally being accepted as important research partners, that we bring a different perspective to the table and that it matters."
During the meeting, Ciccarella also mentored new patient advocates.
"Being diagnosed with breast cancer, it was traumatic," Ciccarella said. "The pain of having to have my breasts removed, the pain of undergoing the surgeries, and even the chemo, it was just overwhelming."
"I mean, when I found out I had it, I was like a mute. And now as a breast cancer research advocate, it's like, I can't stop asking questions," Ciccarella said with a smile.
"Life is funny sometimes. But now I feel really good, really confident. Through the work I'm doing, I've been able to reclaim a sense of self. I'm in a positive place and that's what I want to speak to."
Where breast cancer patients can get areola tattoos
Aesthetic Plastic Surgery/New York Breast Reconstruction Associates, nipple and areola reconstruction; aestheticplasticsurgerypc.com; 33 Northern Blvd., Suite 160, Great Neck; 516-498-8400
Neil Tanna Plastic Surgery, breast reconstruction and 3-D nipple tattoos; breastflap.com; 1991 Marcus Ave., Suite 102, Lake Success; 516-497-7900
Olga Lucia Permanent Cosmetics, areola and 3-D nipple restoration and scar camouflaging, permanentcosmeticsbyolga.com; 1129 Northern Blvd., Suite 301, Manhasset; 516-627-0722
Permanent Cosmetics by Jacqueline Carini, areola and 3-D nipple restoration and scar camouflaging, areolatat.com; private studio in West Islip residence; 516-901-2359
Stony Brook Medicine Bellavie MedSpa, areola Restoration and 3-D nipple tattoos, medspa.stonybrookmedicine.edu; 23 S. Howell Ave., Suite F, Centereach; 631-38-3950