'You'd be complete': Breast cancer survivor pushes for cost of nipple reconstruction to be covered

When Andria Kuntz used to look at her naked body in the mirror, she said she felt "like a monster almost."

The Regina business owner found a lump in her left breast a year and a half ago. She was diagnosed with breast cancer three weeks later.

Because of her family's medical history, she turned down a lumpectomy and instead opted for a double mastectomy. Skin and fat was taken from her abdomen to reconstruct her breasts and blood vessels had to be reattached. The surgery took 15 hours due to complications.

Kuntz said the results of the first surgery were not as planned, so she had a second surgery with implants. She was left covered in scars and had no nipples.

She struggled to adjust to her new body during recovery.  

"You're left with trauma and scars and things that need to heal, not only physically, but emotionally, too."

Then her 24-year-old daughter came across a contest Bliss Permanent Cosmetics in Regina had posted on Instagram, offering areola reconstruction free to one breast cancer survivor. She entered Kuntz without her knowing — and her mother won.

Some surgeons do areola reconstruction, which can include twisting the skin on the breast and sewing it to protrude like a natural nipple. Medical tattooing can be used to define the area of skin. Now, technicians more commonly use a variety of colour tones to make the area appear three-dimensional even if a reconstruction surgery has not been done.

Taylor Vogt, lead technician at Bliss, started doing areola reconstruction (using the tattooing method) four years ago. At the time, she specialized in permanent makeup tattoos. Many of her clients were going through chemotherapy.

"Before breast cancer, nipples aren't something you really think about. It's something private you don't show anybody," Vogt said. "After you lose them and after you've had the reconstruction, you got the implants, you've healed, you go about your day you have your clothes on you feel normal, and then a simple thing like coming out of the shower they're reminded of the cancer over and over."

Vogt said surgeons sometimes do the procedure but the final result is unrealistic or two-dimensional-looking. Many of her clients said they were turned down by traditional tattoo artists, who won't do nipple tattoos and instead suggest art.  

Vogt said that until recently, ink in a variety of skin tone colours only came in semi-permanent pigments. Those inks fade and have to be touched up every one to three years. Recently, permanent pigments in those same colours were released. They are meant to last a lifetime with only minimal touch-ups, as with traditional tattoos.

Vogt said areola reconstruction is now her favourite service to do because of what it offers to her clients. She said she wants more women to hear about the option, but her posts on social media are always reported and taken down within minutes because of some platforms' rules against showing female nipples.

Kuntz said that like many fellow breast-cancer survivors, she hadn't considered options to improve her situation. She said she thought it would cost too much and was afraid it would cause her more pain.

"Anything you can do to make yourself feel better especially after something like this I think is so worth it."

She encourages other women to try the service, but knows that many more would if it was free.

"I think it should just be an automatic option. So many women would just go and get it done and then they would feel better about themselves. And you'd be complete."

The Ministry of Health said it provides very similar surgical coverage for breast cancer reconstruction as other provinces.

In Saskatchewan, women are eligible to receive breast reconstruction surgery following surgery for breast cancer, which may include breast augmentation and balancing procedures.

The ministry said it has allowed coverage of some surgical nipple reconstruction post-mastectomy since 1985, if deemed "medically necessary."

Fat grafting for breast reconstruction is not an insured service anywhere in Canada.  

Areola tattooing is not covered by insurance in Saskatchewan.  

The ministry stated that, to its knowledge, the services of tattooing a nipple has not been identified as "medically necessary" to restore or maintain health.  

Areola tattooing at Bliss costs $399 for one breast and $599 for two.

"I don't understand why they don't think it should be covered," Kuntz said. "I don't understand why somebody would think that getting two lumps put on your chest that are full of scars is considered a breast reconstruction without a nipple."

Bliss offers compassionate pricing on the service, but Vogt said she wishes it was covered by insurance so that all women would have the choice.

She said breast cancer often leads to financial strain for women, many of whom don't work for years during treatment.

"I think there just needs to be an understanding that this isn't cosmetic. It's not something that they're trying to add," she said. "You go into surgery with your nipples. I feel like you should come out with them."