What Are Radiation Therapy Tattoos?

The Purpose and More About Radiation Therapy Tattoos

Doctor talking with patient in office
What do you need to know about radiation tattoos before radiation therapy for breast cancer?. Hero Images/Getty Images

If you will be having radiation therapy for breast cancer, you've probably heard that you will get a tattoo. It's true, but probably not what is going through your mind.  Before getting too worried—especially if you are someone who would ordinarily loath getting a tattoo—let’s talk about why tattoos are done for radiation treatment, how large they are, how they are done, and other things you might wish to know like what they will look like, if they hurt, and if they will be permanent.

Why Are Tattoos Used For Radiation Therapy?

Before having breast radiation, you may need to have skin markings or radiation tattoos put on your breast skin. These marks help your radiation therapist accurately aim the radiation at your treatment area. You may be having five days or six weeks of radiation, and every treatment should be aimed at the same place in order to prevent recurrence and to spare healthy tissue.

The reason for the tattooing is a bit like using a bulls-eye target for archery, darts, or rifle practice. Having a clear target area to aim at improves results.

Blue or Black Tattoos For Treatment Safety

Radiation tattoos will be blue or black and will be created using a drop of ink and a very slender needle. These tattoos won't wash off, so you will be able to shower or swim anytime during treatment without losing these important markings. 

How Large Are The Tattoos And What Do They Look Like?

Your breast radiation tattoos will be tiny—about the size of a freckle, or one millimeter in diameter.

There will often be four tattooed dots, each marking one corner of the area to be radiated, but some radiation centers are now only doing one or two. Having these skin marks in place helps speed setup for each treatment as well as increases the safety and accuracy of your radiation. Radiation tattoos will be created during your treatment simulation before treatments begin.

Where On My Body Will The Tattoos Be Placed?

The good news with tattoos for radiation therapy is that they are often in regions that won't be seen unless you pull out your bikini or even take it off. Even then, the tattoo will appear like a small freckle. when only one or two tattoos are done they are often on the side of the chest, and therefore hidden unless you raise your arms. And, again, a person would have to be very close to you (inches not feet) to see the tattoo, and even then, it will look like a small freckle.

Do Radiation Tattoos Hurt?

You may feel the needle stick when the tattoo is done, but it should hurt no more than a mosquito bite. Many women say that it hurts less than a blood draw or the insertion of an intravenous needle for chemotherapy.

Will Radiation Tattoos Be Permanent?

Most radiation tattoos will be permanent. Some radiation therapists use skin markers instead of permanent tattoos. While some women may prefer a "reversible" method such as this, it will be important to make sure these temporary markers are kept dry until the end of therapy. In other words, if the temporary markers become wet, you could risk your radiation therapy being inaccurate (not good) or having to go through the process (often uncomfortable) once again in which you are "fitted" for the mold that goes over your chest during treatment and measurements redone.

Side Effects of Tattoos

There are very few side effects related to the use of tattoos for breast cancer radiotherapy. An older study makes note of a few people who had allergic reactions to the dye used for tattoos, but this appears to be extremely uncommon.

Other Options

Studies are in progress looking at an alternative to "visible" tattoos for radiation therapy. One study found that women who had "invisible" tattoos applied (using fluorescent dye) had improved body image relative to those who had conventional visible tattoos.

Coping With Radiation Tattoos 

Coping with radiation tattoos is easier if you can understand their purpose now, know that they may be able to help doctors know where you received radiation therapy in the future, and if you view them a symbol of having completed treatment.

With so many aspects of breast cancer treatment, cognitive reframing is helpful in coping with radiation tattoos. Reframing is a technique in which a situation does not change, but your attitude toward the situation does change. An example (fairly extreme) might be that instead of mourning the loss of hair on your head, being happy and pleased that you don't have to shave your legs for the 5 or 6 months of chemotherapy. Instead of thinking of radiation tattoos as an evil leftover, you can view them for what are—a mark of survival! Your radiation tattoos can serve as a reminder that you are a breast cancer survivor

These tattoos also provide a visual reference for other doctors who may need to know where you received radiation.

Radiation Tattoo Removal An Option If Needed Emotionally

Despite these coping tips, some people are still very bothered with their tattoos. If your chances of recurrence are very low and your oncologist agrees, you may wish to consider having treatment to remove the tattoos. Options available include surgery, dermabrasion, and cryotherapy. See a plastic surgeon or dermatologist about tattoo removal, if you plan on removing these skin marks.

Bottom Line on Radiation Therapy Tattoos

Many women feel that their radiation tattoos are marks of survival and strength rather than something they want to have removed. As tattoos have become more common for women of all ages, you won't be the only tattooed lady at the swimming pool. You can keep them as they are and not feel out of place.

You may even decide to turn your tattoos into a creative design to celebrate your survival. If you've never been inked before, this can be the incentive to take the plunge. You can add a design around the small therapy tattoos to express your personal style and make them meaningful.

As we talk about making your tattoo part of a creative design, or at least reframing, it's important to point out that the emotional and physical consequences of cancer are not always bad things you must deal with. Learn about how having cancer changes people in good ways, not just bad, and the many positive ways in which living with cancer influences our lives.

Sources:

Landeq, S., Kirby, A., Lee, S. et al. A Randomized Control Trial Evaluating Fluorescent Ink Versus Dark Ink Tattoos for Breast Radiotherapy. British Journal of Radiology. 2016. 89(1068):20160288

Rathod, S., Munshi, A., and A. Jaiprakash. Skin Markings Methods and Guidelines: A Reality in Image Guidance Radiotherapy Era. South Asian Journal of Cancer. 2012. 1(1):27-29.

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