MADRID - Arms covered in red and green ink, tattoo artist Alvaro Quesada is hardly what cancer survivors expect at a Madrid infirmary, the first public hospital in Spain to offer nipple and areola tattooing.
Yet his service of tattooing realistic-looking nipples onto women who have had their breasts reconstructed after mastectomies signals the final step of recovery from cancer, and women react with emotion to the process.
"They leave crying and hugging me. This is therapy," says 32-year-old Quesada, who takes time out from his tattoo parlour to attend patients at the hospital.
Reconstruction can occur months, or even years, after breast cancer surgery with tissue expanders typically installed to stretch the skin and make room for a future implant. Creating the nipple comes later and involves one more operation.
"At this point most patients are exhausted," said Lorenzo Rabadan, the doctor who first approached Quesada about providing women with an alternative to surgery. He invited the tattoo artist to train staff on the technique.
Clutching a pale pink tattoo gun, Quesada creates the three-dimensional illusion of a nipple on a patient's reconstructed breast, mixing colours with names like 'rose pink', 'brown sugar' and 'tribal black' to mimic the natural shade of an areola.
Half-blind, Quesada offers his service free of charge. The national health service did not cover the cost of his false eye after he lost his left eye to a benign tumour.
For many, a quick and relatively painless session marks the end of a chapter.
"This means it's over and I can pick up my life again," said Mamen Malagon, 43. She was diagnosed with the disease in 2011 resulting in the mastectomy or removal of her left breast.
"All done," she sighed as she got dressed. "Do you know what it means to say that it's over?"