When asked about his work inking 3-D tattoos, Vinnie Myers doesn't highlight the orange fish with two dozen scales that twists and writhes up the shoulder of the man featured on his website. Nor is it the Maori hook that pops in bright green, emphasized by texture and shadowing.

  These days, Myers immerses himself in a gig that involves the same basic vision, day after day: implanting pigment into skin to create the illusion of a real nipple and areola.

  What may be lost in artistic freedom is more than made up for in job satisfaction, Myers says. For thousands of women, his tattoo chair has been the last stop in the long process of what he calls "being made whole again" after reconstructive surgery following breast cancer.

  "What a woman's face can say explains it in a glance," Myers says. "Every time I see them look in the mirror and well up with tears, or even cry, or hug me. ... It's hard to explain what that makes me feel like. But every day I'm wowed by it."

  Myers, who has been tattooing since he was a U.S. Army medic in the 1980s, didn't always dream of being a tattoo artist for mastectomy patients. As he chronicled in a blog for those with breast cancer, it never even crossed his mind for most of his career. "Twenty-five years ago or so, if someone had said to me, 'One day you'll be tattooing nipples on women who have battled breast cancer,' I would have said they were crazy," he wrote.

  That was in 2012. Since then, he estimates he's worked with nearly 9,000 mastectomy patients from around the world. His client list includes women treated at Johns Hopkins Hospital in Baltimore, Lankenau Hospital in Wynnewood, Pennsylvania, Capital Area Plastic Surgery in Saratoga Springs, New York, Microsurgical Breast Reconstruction in Charleston, South Carolina — and New Orleans' Center for Restorative Breast Surgery.

  It's not that Myers didn't enjoy traditional tattooing; he still keeps a blog chronicling the work he did at his first shop in Westminster, Maryland, in 1991, and his 3-D designs later in his career. In 2002, however, he got a phone call that would ultimately catapult his career in a different direction. That was the year he first tattooed a nipple on a cancer survivor, after a Baltimore plastic surgeon called him when a nipple tattooing session "didn't go so well."

  At the time, Myers said, he was unaware of the "powerful impression" or the "overwhelmingly positive psychological impact" the reconstruction work would have on him and the women he was tattooing.

  Six years ago, he got another life-changing call: His sister was diagnosed with breast cancer at the age of 46. That's when he decided to make his part-time work tattooing nipples a full-time job.

  "It changed the way I looked at it," Myers said. "It made me realize that this really affects every single family and every woman who gets it very much."

Although the world of nipple tattoo artists is small, breast cancer survivors in New Orleans have options. Among those who have dedicated themselves to the craft is Carole Dezarn, the owner of Softouch Permanent Makeup in Kenner.

  Dezarn, who has been tattooing mastectomy patients for nine years, learned the craft as part of her training on restorative medical tattooing, a branch of permanent makeup tattooing catering to creating realistic results for cancer and other medical patients. She estimates she's provided the service for nearly 300 breast cancer survivors.

  "We are working on a canvas that is far from perfect," Dezarn said. "We have to do a lot of imagination; a lot of artistry." The most difficult part of the job, she added, is tattooing patients whose surgeries have left them with significant scarring or very uneven breasts: "We have to get them symmetrical, and we have to make it look like nothing is wrong."

  Like Myers, Dezarn described her work as a "passion," done with the goal of giving relief to women who have had breast cancer. Her company only charges the amount her patients' insurance companies will cover; breast cancer survivors pay nothing.

  Dezarn, who relies on word-of-mouth to inform women about the tattooing service, even offers clients free T-shirts with "tattoo the tatas" written on the front.

  "The reason it's a passion for me is because one day it may be me that needs to get through this long road to recovery, after having breast cancer," Dezarn said. "I'm getting chills just thinking about it."

  Stacey Colangelo, who trained under Dezarn, works at Treasure Tattoo in the Faubourg Marigny. She also tattoos women who have had a mastectomy, and there's no cost to them.

  Colangelo estimates she's done nipple and areola tattoos for about 20 women in the last four and a half years, and said each job ended up being a "beautiful" experience for both her and those who got tattooed. "I had a woman once who right after she got them done, was walking around the tattoo shop topless," she said with a laugh. "It's just such a relief for them. It's like the final piece of the puzzle of getting their life back."

Denise Cazaubon, a 49-year-old CPA and lifelong New Orleanian, can attest to just how much breast cancer can change lives. She is one of three sisters who all have been diagnosed and treated for breast cancer in the past two years.

  Cazaubon, who was diagnosed in 2015, opted to get a kind of procedure pioneered at the Center for Restorative Breast Surgery that uses tissue from the abdomen to fill in what was lost during her double mastectomy.

  Although it was still a fairly new surgery, she took the plunge in part because after diagnosis she discovered how important realistic breasts were to her, post-surgery.

  "At the time I may have been a little bit of a deer in headlights, going through the emotional health side of it," Cazaubon said. "It was a little overwhelming, and I wanted to make sure the cancer side was taken care of. Then I realized how important reconstruction is. Given the option, you take it."

  Although Cazaubon opted to get reconstruction using her own tissue, not every breast cancer survivor follows that path. Cazaubon said she and her sisters all chose different treatment options. One sister chose not to have surgery at all, and instead was able to treat the cancer using chemotherapy and radiation. Another had a mastectomy, but did reconstruction using implants, rather than tissue. And still other patients opt to have surgery, but not reconstruct breasts at all, or to reconstruct breasts, but not nipples.

  "I've learned it's unique," Cazaubon said. "Everyone has a different path. It depends on when you catch it, how you catch it, what's the outlook."

  Cazaubon opted for three-dimensional tattooing. And a year later, she said she not only "feels good," but both she and her husband have "no regrets" about her reconstruction. "Looking in the mirror, with tattoos and nipple reconstruction, it's amazing what they look like," she said.

Cazaubon isn't alone in her decision. According to the American Society of Plastic Surgeons, the number of reconstruction procedures increased in 2015 by 4 percent from the year before, to more than 106,300. The numbers are up about 35 percent since 2000, according to the society's website.

  Just as the number of reconstructions are increasing, the new techniques available at the Center for Restorative Breast Surgery on St. Charles Avenue are also becoming increasingly popular, according to spokeswoman Liz Bodet.

  The facility is a posh, two-story site complete with spa-like waiting areas, hotel-inspired patient living areas and an on-site kitchen. During a tour, staff underscored the importance of patients feeling calm and even pampered.

  But employees also emphasize that the reconstruction procedures and tattoos are financially accessible to women of all backgrounds. That's because of the 1998 Women's Health and Cancer Rights Act, a federal law that requires all health insurance providers who cover mastectomy procedure to also cover the costs of breast reconstruction.

  Employees with the center would- n't reveal the average cost of reconstructive surgery, saying the prices vary depending on the work done. But, according to the American Society of Plastic Surgeons, the average surgeon's fee for breast reconstruction surgery in the United States is about $3,000 to $4,000, and can run as high as $8,000.

  Dr. Whit Wise, a surgeon who has been doing reconstruction since 2005, said the center is unique because insurance covers a procedure that is more individualized than what patients might get in hospitals elsewhere. That's largely because the staff recognizes how important final outcomes of mastectomies can  be for the overall physical and mental health of breast cancer survivors.

  "We want them feeling both feminine and whole at the same time," Wise said. "If they're not comfortable, we're not happy."

  Myers agrees. He adds that the nipple tattooing portion of the work, which averages about $600 and is covered under the 1998 law, is like putting the "cherry on top" of the whole process.

  "This ends the journey these women have been on, possibly for years," Myers said. "The life-changing events, the big surgeries. This is a final thing that brings it all to a close for them."

  Myers has been traveling to New Orleans to tattoo nipples on breast cancer survivors since 2012, when he first joined the team at the Center for Restorative Breast Surgery.

  The center offers the tattooing as a last step of what is dubbed the "most advanced methods of breast reconstruction" in the field. Using microsurgical techniques, doctors offer the option of using real tissue to recreate breasts, rather than relying only on implants. And in cases where the nipple has to be removed during surgery, the center takes painstaking efforts to adhere to the surgeons' goals of making sure the breast still looks as real as possible, Bodet said.

That is where Myers comes in. For some women, Myers creates a 3-D tattoo, using varying shades of pigments to create the illusion of dimensions and small bumps that one would expect to see on an areola and nipple.

  Another option, which Bodet calls the "ultimate in nipple recreation," is called 4-D nipple construction, and it takes the tattooing process a step further. Surgeons create a three-dimensional nipple out of flesh, and then Myers tattoos the details.

  "The plastic surgeons are like sculptors," Bodet said about the process. "And Vinnie, he's applying the paint."

Are you a local tattoo artist or tattoo parlor that offers free or discounted tattoos for women undergoing breast reconstruction? Gambit would like to hear from you for an online directory of resources. Please email response@gambitweekly.com.