NYS Bill A5729A overlooks a critical reality
Kathy Hochul, New York State Governor
On October 3, 2024, Kathy Hochul signed bill A5729A into law that in summary states “Requires insurers to provide coverage for tattooing of the nipple-areolar complex pursuant to or as part of breast reconstruction surgery if such tattooing is performed by a physician or other health care practitioner working within their scope of practice.”
The Alliance of Medical Tattooing has officially submitted a letter advocating for the urgent amendment of New York Bill A5729A. The proposed amendment seeks to include licensed tattoo artists as covered providers for performing nipple-areola tattoos for breast cancer patients. This change would ensure that breast cancer survivors have access to skilled professionals for these critical restorative procedures, enhancing both their physical and emotional recovery. The AMT firmly believes that trained tattoo artists play a vital role in the post-surgical care of survivors, and this amendment is a crucial step toward improving patient outcomes.
Letter to the NYS Assembly Members: Urgent Need to Amend Bill A5729A
Dear Assembly Members and New York Representatives,
I am writing to you on behalf of the Alliance of Medical Tattooing, a non-profit organization dedicated to the advocacy and well-being of cancer survivors through medical tattooing. We represent licensed professionals whose careers are focused on improving the lives of individuals with damaged and/or compromised skin, such as breast cancer survivors, through the use of specialized techniques and adherence to the highest standards of practice.
Therefore, I would like to express my deep concerns regarding Assembly Bill A5729A, which requires insurers to cover the tattooing of the nipple-areolar complex for breast cancer survivors, provided a physician or healthcare practitioner performs it, notably excluding tattoo artists who perform this practice professionally. This is particularly surprising due to the inclusion of Title 8 professionals within the bill, despite them potentially lacking the practical experience in tattooing that tattoo artists themselves have.
Breast cancer survivors, through their survivorship journey and due to the scarring and body-altering aspects of treatment, often experience body image disturbance, impaired self-identity, a perceived loss of control, etc (Fingeret et al., 2014; Lowery et al., 1993; Miller, 2015). These tattoos represent an opportunity for cancer survivors to regain control over their bodies and improve their body image (Proctor, 2024), as I am sure you are aware from the bill's creation.
Our organization has documented case studies that illustrate the poor quality of nipple tattoos performed in hospitals and in numerous plastic surgery offices across New York State, as well as other states and countries. The results often include scarring so severe that survivors are unable to have the tattoo corrected. In the worst cases, survivors have developed necrosis from improper techniques, leaving them with pitted and disfigured skin where their nipple tattoos should have been. The typical result among these cases is the same: faded, mottled ink circles that resemble nothing close to a natural nipple-areola complex.
Although we do not dispute the quality of work that some healthcare providers do (Maselli et al, 2024), it has likewise been evidenced that tattoo artists who engage with this practice facilitate similar positive results, which lead to better psychological outcomes for breast cancer survivors (Daly et al., 2024, Becker & Cassisi, 2021, Proctor et al., 2024). This evidence is unsurprising, considering the numerous testimonies AMT and our registered artists have received to this effect. Furthermore, several of our artists have been trusted to give these tattoos to individuals who have received low-quality nipple tattoos from some healthcare professionals.
Additionally, there is the issue of cost. Doctors charge anywhere from $2,000 to $13,000 for tattoo procedures. This does not include the cost of operating room time to perform nipple tattoos, used in some instances, which can exceed $10,000. This is an exorbitant fee for subpar work that leaves survivors emotionally distressed and physically scarred. By comparison, licensed tattoo artists who specialize in medical tattooing charge between $600 and $1,000 for bilateral nipple tattoos, which often include touch-up sessions. The quality of the work provided by these artists typically far surpasses that of the medical professionals, yet the law gives preference to doctors who are not adequately trained in this highly specialized area. The Alliance of Medical Tattooing has collected letters from survivors who have bravely come forward to share their experiences. Many of them are willing to speak directly to the Assembly to bring a voice to the importance of the inclusion of tattoo artists within this bill; however, they were unable to due to a lack of opportunity for sufficient public debate.
I commend you for this important bill; however, by not allowing breast cancer survivors to choose how they receive life, body, and identity-changing treatment, you are removing the very autonomy and control that was taken from them by cancer, which they are fighting to get back. The Alliance of Medical Tattooing urges you to revisit and amend Assembly Bill A5729A to include licensed tattoo artists of the cancer survivors' choosing as covered providers under insurance. This change would not only lower costs for insurers and survivors but be in line
with the Women's Health and Cancer Act 1998 and previous Legislative Position Papers (A.5729 /S.6146), which highlight the need for nipple reconstruction for breast cancer survivors without the exclusion of skilled, trained, and licensed tattoo artists.
Thank you for your time and consideration. I hope that we will be able to collaborate to improve this law for cancer survivors. I would be happy to provide more information, including case studies, survivor testimonials, and additional research, to support the urgent need for this change. Together, we can put the power of choice back in the hands of breast cancer survivors.
Sincerely yours,
Nicole M. Rizzuto
President, Alliance of Medical Tattooing Licensed Tattoo Artist, Nassau County, New York