Despite the many shades of patients' skin tone, "The color choices for doing it in the hospital setting were beige, dark brown and the most common color, called 'salmon,' " Shockney said. She chose salmon and the result, she said, "looked like two pancakes."
"Nobody can see what I've got going on underneath my clothes or inside my bra, but I know it," Shockney said. "It's not just because you want to look nice when you're intimate with your partner; you want to look nice because it's you."
In the past 10 years, Myers — working out of Little Vinnie's Tattoo Parlor in Finksburg — has tattooed more than 3,000 patients with 3-D nipple images. He has developed a method of adding dimension to make the nipples look strikingly realistic — what he calls the "basic principles of light and shade in Art 101." Johns Hopkins Hospital has begun referring breast cancer patients to Myers. And after realizing the impact his work has on these women — including his sister — Myers now focuses solely on nipple tattoos.
"It brings closure to them," Myers said of his customers. "I've heard that so many times. It's a huge thing for them — much larger than I ever would have imagined would be possible."
Nipple tattoos are only one possible part of the breast reconstruction process, which includes several steps and is performed locally by Baltimore surgeons such as Dr. Bernard W. Chang at Mercy Medical Center. In 2008, the Millennium Research Group estimated that 110,000 women chose the reconstruction option that year.
Myers had always enjoyed art and began tattooing while in the Army as a way to make extra money. Myers opened his own shop in 1991 but traveled frequently for the next 10 years.
In 2002, Towson plastic surgeon Adam Vasner contacted Myers to see if he would be interested in tattooing nipples on women with reconstructed breasts.
"I had to give it a try," Myers said. "The first few, I didn't get quite how much of an impact it had, but as time went on, I started to realize that it was a much bigger thing than I thought."
Before the advent of 3-D nipple tattoos, women who had breast reconstruction surgery had two options: reconstruction of the nipple and areola, which could flatten and fade over time, or leaving the breast with no nipple at all.
There are other tattoo artists who specialize in 3D nipples, from as far away as Portland, Ore., to as close as New York. Vyvyn Lazonga, who has offered 3-D nipple tattoos for years, said it's still an anomaly — but might not be for long.
"We're kind of spread out all over the world; it's not like we have one on every block," she said. "There probably will be in my lifetime, though."
Shockney said Myers is better than any other tattoo artist she's seen. Myers has developed a general process but changes his approach slightly for each woman, based not only on skin color but reaction to surgery.
He first draws the circles where the nipples and areolas would be, mixes the colors and then tattoos it on, taking care to draw in the Montgomery glands, the bumps that surround the nipple.
The procedure costs $400 for one or two standard nipple images (one costs the same as two because Myers has to match the tattoo to the color and texture of the patient's natural nipple, which is more challenging).
Tattoo artists must be well-practiced before attempting nipples, according to Chris Keaton, owner of the Baltimore Tattoo Museum. He likens it to tattooing portraits.
"A lot of plastic surgeons have tried to do it themselves, but because they weren't actual tattoo artists, didn't do it as well," he said.
The demographic of Myers' patients is as diverse as the images they choose. Myers said he worked with the wife of the Disney family's money manager as well as an oral surgeon from Saudi Arabia who said she would be forever unmarried because losing one breast meant she was "damaged goods" in the eyes of Arab society.
Myers said the women who come to his shop are generally Marylanders or from the Northeast region. He encourages others to go to the Center for Restorative Breast Surgery in New Orleans, where he travels once or twice a month for a week's time to continue his work with 3-D nipple tattoos.
"You wake up from the operation, and you have no breasts; you just have these horrible scars, and you're jolted with that reality initially," he said. "You have to go through all these other stages along the way and slowly, piece by piece, you feel like you're getting back to where you were."