As with all the choices you’ll make about your future breasts, finding an expert, in this case an experienced tattoo artist, is super important. One such practitioner is the mastectomy tattoo artist Stacie-Rae Weir, 46, of Austin, Texas. Weir’s work is based in personal experience. In 2008, not long after her mom died of ovarian cancer, Weir learned that she carried the BRCA1 mutation, which raises the risk of breast and ovarian cancer. Weir spent the next four years learning more about her mutation and, in 2012, in light of her enhanced risk, decided to have a prophylactic mastectomy that involved removing her nipples. She had reconstructive surgery and, as part of it, sought nipple tattoos from a permanent-makeup trainer. Because the woman was experienced, Weir expected good results. She didn’t get them. “She didn’t understand tattooing scar tissue and destroyed my skin,” says Weir. Weir replaced the botched nipples with a peacock feather tattoo done by her protégé, Samantha Rae. And the experience prompted a career pivot. Weir began focusing on the art of the mastectomy tattoo, including drawing realistic nipples and learning more about how to work with skin that has been scarred. “My own botched nipple tattoos motivated me to make sure other women never had to feel that bad about their body again,” she says. In 2013, she launched A.R.T. (Artistic & Areola Restorative Tattoo)to teach artists how to tattoo breasts, and she has now trained almost 100 tattoo professionals in person and almost 300 online. Along the way, she partnered with World Famous Tattoo Ink to create an array of areola pigments that are considered to be the first-ever permanent pigments that closely simulate the color of areolae and don’t fade over time as typical tattoo inks often do. She also helped design special needles to be used specifically on scar tissue. Weir says there’s lots to know about getting a breast tattoo. Here are the five main things to consider as you start the process.

1. Wait Until Your Scars Are Fully Healed

You may be in a hurry to finish your reconstruction and be done with it. But that’s not the right call, says Weir. “If your scars are still maturing, a tattoo can cause damage and destroy new tissue,” she says. “Surgeons will say to wait three months to get your tattoo.” She says it make take longer. “Everyone’s body heals at a different rate,” she says. “You’ll know your skin is ready when your scars are no longer red,” she says.

2. Research the Tattoo Artist

Before you book your tattoo appointment, ask to see the artist’s drawings and, if you’re having them do nipples, make sure their drawings look like realistic nipples.

3. Make Sure the Artist Is Experienced With Scars

There are currently no official medical tattooing regulations or standards, but artists can choose to educate themselves. Make sure the artist has been working for at least three years and has taken in-person training on how to tattoo scars. “There are more bad nipple tattooists out there now than good ones, and it is buyer-beware,” says Weir. “Scars are difficult, and a mastectomy is an amputation site where the skin has been stretched,” she says. “The whole area is scar tissue that has been separated from breast and mammary tissue, so you need to seek out someone who has many years of experience.”

4. Expect the Process to Be Triggering

You may expect the tattoo experience to be empowering. And it probably will be. But it might also bring up intense and difficult emotions, says Weir. “When you’re put under during a surgery like a mastectomy, the body can’t defend itself, and tattooing can trigger memories of that experience,” she says. “This can lead to a huge stress response from a person when we work on the area again, including an increased heart rate, anxiety, sweating, breathing heavily, or looking for a way to leave the room,” says Weir. “Both you and the tattoo artist need to be prepared for that experience.”

5. Ask the Practitioner How They Will Help You if Emotions Arise

Weir feels so strongly about allowing for the emotions that can rise during a tattoo that she became a certified trauma coach and incorporates an atmosphere of trauma release during tattooing sessions. She leads clients through focused breath work before the tattooing begins (each nipple-areola complex takes about 20 minutes) and listens to whatever her clients are trying to express. “I give my clients permission to deeply feel however they’re feeling,” she says. “I tell them to breathe into their feelings and to stop holding those feelings in.” Not all artists may handle the emotional aspect of the tattoo process the same way, but all should have a way to “hold space” for their clients, she says.