Penny had never been to a tattoo parlor, like nearly all of the 2,000 women here before her. But she wasn't as nervous as she had expected.
"Stand up for me, darlin'," Vinnie Myers said.
He studied her breasts.
"There is some asymmetry, obviously," said Vinnie. "So we're not going to be able to get them exact."
"I know," she said. "But like my doctor told me, 'They're not twins, they're sisters.' "
"That's right," laughed Vinnie, who is tall, trim, and always works in a porkpie hat, because he doesn't want women staring at his shaved head.
Vinnie took a peach-colored Sharpie and drew concentric circles where the areola, the dark area around the nipple, and the nipple itself ought to be. First on her right breast, then her left.
"This is the main thing that you do?" Penny asked him.
"Yep. Just nipples. No more Tasmanian devils for me."
Vinnie, 50, started out in Army boot camp tattooing serpents on soldiers. In the last decade, in a wonderfully American evolution, he has become almost a folk hero in the breast cancer world, saluted and admired by doctors and patients alike.
He has perfected the three-dimensional nipple tattoo, restoring a final mark of femininity to at least three women a day, who have come from as far as Saudi Arabia and Brazil to Vinnie's Tattoo Parlor in a strip shopping center 30 miles west of Baltimore.
"His results are just so superior to what else we've seen, and I've seen nipples from all over the world," said Marisa Weiss, founder of BreastCancer.org and a radiation oncologist at Lankenau Hospital. Many area hospitals are now using tattoo artists.
"Women have been through so much," Weiss says, "and then they make a big commitment to reconstruction, and if the nipple doesn't look good, it screws up the whole thing. It's hard to get a perfect result from reconstruction. But if you get a great nipple in the middle, it distracts the eye, which is very forgiving. It doesn't see the scars or imperfections, or little bulges; the eye goes to the nipple, and nipples rule. Definitely."
This is certainly what Penny, secretary to a Maryland state court judge and mother of three, was hoping for. When Vinnie finished outlining circles with his marker, she faced the mirror again.
"Better than what I have now," she said.
"I can just give you the Sharpie," he quipped. "You can draw them every morning."
"Takes me too long to do my hair and stuff," she said. "I don't have time for that."
Penny sat back in the artist's chair. Vinnie put a blue drape over her. He leaned her back, as a dentist would.
"Let's go, darlin," he said."
Vinnie stumbled into this meaningful life quite by accident. He joined the Army at 18, and his roommate in boot camp was a heavily tatted grunt from Long Island. The roommate saw Vinnie sketching all the time, sketching, sketching, and saw he was a terrific artist and persuaded Vinnie he should get into tattoos. So Vinnie experimented on some "not so bright MPs" and developed his art.
His was a conventional tattoo existence - fighting the stereotype, the public's disdain - until 2001.
Vinnie got a call from a Baltimore plastic surgeon, who was doing nipple tattoos during breast reconstruction. But he wasn't very good. He asked Vinnie if he'd give it a try on some of his patients.
Vinnie did. He started learning all he could, and felt techniques used by mainstream medicine were primitive.
"The industry standard has always been draw a circle where the nipple should be and color it in," Vinnie said. "When I first started doing it, I said to myself: ''Why should I do a tattoo of a nipple and make it look like a pepperoni, when I can make it look like a nipple?' "
Here are the facts:
About 290,000 women will get diagnosed with breast cancer this year. About 50,000 will get reconstructive surgery, and 90 percent of those get some sort of areola. But it can be unsatisfying, with no image of a nipple. Furthermore, says Vinnie, surgeons often use vegetable-based dyes that fade quickly.
Vinnie developed a better-looking nipple, and the world began to notice.
In 2008, Vogue magazine wrote one paragraph about Vinnie. A patient at the Johns Hopkins Breast Center read it and asked staff there about Vinnie, since he was local, and whether they would recommend she go see him. The answer in both cases was no.
But the patient went to see Vinnie anyway, got the tattoos, and returned to Hopkins to show Lillie Shockney. She is the administrative director of the Hopkins center, a renowned figure in breast cancer circles, and a survivor who's had double mastectomy and reconstruction.
Shockney visited Vinnie, got the tattoos herself.
When she finished crying, she asked Vinnie: "How busy do you want to be doing this? You have no idea."
The right tint
Penny lay back in the chair, her chest exposed.
"I've been in this position way too many times," she said. "But this is a good thing. You're not going to cut on me, right?
"No, darlin'," he said.
Vinnie's workplace feels clinical. He wears purple latex gloves, like any health professional, although clients often suggest he wear pink ones, something he's considered.
He leaves the room while his patients undress and dress, just another way to keep the feeling professional.
He has an assistant, Richie French, home from two tours in Afghanistan, who is tattooed from head to toe but wears an Oxford shirt and tie. He is like a dental hygienist, preparing the space, wiping down the instruments, putting fresh plastic over the wires of the tattoo guns, setting up a row of little cups, the size of toothpaste caps, in which Vinnie will squirt all his colors. Vinnie starts with a basic mix, but he tints each one differently, even finding use in Penny's case for a dab of turquoise.
"You're really fair with a slightly yellow tint to your skin," he told Penny. "So I have to account for that. I'm going to go somewhere between a mauve and a suntan brown. I think that will work for you."
Penny, from Bel Air, Md., liked the sound of that, suntan brown. A day at the beach. She relaxed.
Vinnie rubbed a diaper cream like a petroleum jelly on the work space, then began to paint his canvas.
He alternated between two tattoo guns, one is a shader, the other a liner. The guns sounded like an electric shaver.
Because of nerve damage from their mastectomies, many women don't feel significant pain. Some surely do, but the range of discomfort varies from one woman to another, from one breast to another.
Vinnie said with certainty that if these nipple tattoos felt like other tattoos, "none of these women would be sitting here."
Penny felt the tattoo gun for sure. "Kind of feels like a needle when they numb you," she said, and later described it as "bee stings." But she was easy, a model client, the pain insignificant compared with all the pain she had experienced before, and as Vinnie worked, he and Penny continued a relaxed conversation.
"My husband encouraged me to come," she said of the man she met at 14 and married at 18. "He is the only one who will see me. He wanted me to feel more like myself."
Vinnie first tattooed in the lines of the two circles, then started shading the areola, making his way to the nipple itself. He also took special care to do what are called Montgomery Glands, the little raised dots in the areola.
Creating a three-dimensional image, the appearance of a raised nipple, is all about using light, shadow, and color to create illusion. This is what distinguishes a gifted artist.
Doing one breast on a woman is actually harder than doing both, and can take longer. When Vinnie's doing two breasts, after a double mastectomy, he can use the same color on each and knows they will look alike. But with a single breast, he has to match his tattoo with the color, texture, and shading of the existing nipple, and that can be tricky.
"You should teach other artists," Penny suggests.
"I'd like to," he says. But right now he can't. He recently signed a contract with the prestigious Center for Restorative Breast Surgery in New Orleans to do tattooing there one week every month. He has no time, and also stopped regular trips to Lankenau.
Vinnie charges $400 per client, what he feels is a fair price, and says that because of the Women's Health and Cancer Rights Act of 1998, insurers will cover them, though often not without a fight.
"We found over the years," he said, "first they needed a diagnosis code, than a CPT code, then a prescription, and over time we've learned what these things were, so now we tell the ladies. And they submit these things with their receipt."
Covering and uncovering
About two years ago, Weiss, the Lankenau physician, led a bus trip of 10 women to meet Vinnie. She'd heard about him from Shockney.
Rather than go to his parlor west of the city, the women met Vinnie on a yacht in Baltimore's Inner Harbor. One by one, they went into a state room with him, showed their breasts, and he did evaluations and set appointments.
"We went nipple shopping. Really, we did," said Nancy Schmidt, one of the 10. "We looked at all of his pictures, and all of the women were showing their breasts and saying, 'What do you think?' It was like having a private consultation with a doctor, except he was a tattoo artist."
Afterward, they all went to lunch.
Vinnie dresses nicely, in slacks and a long-sleeved collared shirt. When he's working, he has no visible tattoos. He promised his wife years ago that he'd keep them off his neck and forearms, hidden from view in any professional setting.
But his back and chest are covered with body art, and these 10 women from Philadelphia wanted to see it.
They told him to take off his shirt.
"Now?" he said meekly. "In the middle of this restaurant?"
"Yes," they insisted. They had all taken their shirts off in front of him. He was embarrassed but stood and unbuttoned in front of all of Baltimore.
"It gave me a really good perspective of what it's like for them," he said.
Schmidt, a nurse from Rosemont, was the first of the Philadelphians to get tattoos from Vinnie.
"I love them," she said. "He picked the perfect color, the perfect size. I feel I could undress in a female locker room, and I don't think women would notice."
After an hour in the chair, Penny was finished.
He had her sit up, and look at herself in the mirror.
"Wow. That is amazing. It's been almost two years since I had a nipple. It's really incredible. It really makes the scar look less there."
There were days she thought she would die from cancer, never have breasts again, and never feel like a woman again. And here she was staring at what looked like healthy normal breasts, with fabulous nipples.
"It's incredible," she repeated.
"I'm going to go to Victoria's Secret and get a pretty bra."
"It's got to be see-through," said Vinnie.
She was not really listening to him, lost in her thoughts.
"I feel complete again," she said. "Now I can feel like I'm done."
"You are," said Vinnie.
He left the room, so she could take her time, enjoy the moment, and get dressed.
Several area hospitals work with tattoo artists or use experts on staff. They include:
Mandy Sauler, a medical cosmetic tattoo artist in Exton, spends two days a week at Penn Plastic Surgery in West Philadelphia.
Cooper University Hospital in Camden refers patients to Stephanie Curran from Forever Fabulous in Marlton and Rose Marie Beauchemin of the Beau Institute in Mount Laurel.
At Fox Chase Cancer Center, a staff nurse creates 3D tattoos.
Abington Memorial plastic surgery chief Brian Buinewicz tattoos nipples and also collaborates with a tattoo artist.
goes to Jefferson Plastic Surgery once a month, and Nicole Shevchenko of Cherry Hill works
with Jefferson surgeon Anne Rosenberg in South Jersey.
- Michael Vitez
Contact Michael Vitez
at 215-854-5639 or firstname.lastname@example.org. On Twitter @michaelvitez.