{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T20:59:11Z","timestamp":1790369951784,"version":"4.1.0"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Academic College of Tel Aviv - Jaffo"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Support Care Cancer"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Breast cancer and subsequent mastectomy result in significant physical and emotional changes, including damaged body image, compromised sense of femininity, diminished self-esteem, and profound experiences of grief and loss. While reconstruction procedures are routinely offered, some women choose artistic mastectomy tattoos as an alternative means of reclaiming their bodies and reconstructing identity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Grounded in the Dual Process Model of Coping with Bereavement, this study explored how women utilize post-mastectomy tattoos as coping mechanisms and meaning-making processes following breast removal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative study combining thematic analysis of semistructured interviews with social semiotic analysis of mastectomy tattoos. Twelve women (mean age 44.5\u00a0years, range 30\u201356) who underwent mastectomy: 11 followed by breast reconstruction and one with a flat closure, and subsequently chose mastectomy tattoos participated in interviews conducted June 2023\u2013April 2024. Data were analyzed to identify emerging themes and visual symbolism.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three primary themes emerged: (1) bodily perceptions post-surgery\u2014characterized by damaged body image, feelings of alienation, compromised femininity and wholeness, and struggles with intimacy; (2) mastectomy tattoos as coping mechanisms\u2014involving restoration-focused planning and meaning-making processes; and (3) mastectomy tattoos as reclaimed identity, fostering renewed sense of belonging, confidence, and bodily control. Semiotic analysis revealed tattoos symbolized personal growth and transformation, freedom, and reconnection to nature and life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Mastectomy tattoos serve dual functions within the grief process: facilitating confrontation with loss while enabling restoration-oriented coping and identity reconstruction. Findings support incorporating artistic tattooing into post-mastectomy care options and expanding insurance coverage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00520-026-11144-5","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T19:35:32Z","timestamp":1787859332000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\"This is the first time I felt they're mine\": the significance of tattoos in coping and identity reconstruction following mastectomy"],"prefix":"10.1007","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1807-0555","authenticated-orcid":false,"given":"Tsipi","family":"Hanalis-Miller","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8941-4705","authenticated-orcid":false,"given":"Avital","family":"Genkin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5111-5252","authenticated-orcid":false,"given":"Avital","family":"Gershfeld-Litvin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"issue":"2","key":"11144_CR1","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1111\/jmwh.12932","volume":"64","author":"CL Farley","year":"2019","unstructured":"Farley CL, Van Hoover C, Rademeyer CA (2019) Women and tattoos: fashion, meaning, and implications for health. J Midwifery Womens Health 64(2):154\u2013169. https:\/\/doi.org\/10.1111\/jmwh.12932","journal-title":"J Midwifery Womens Health"},{"key":"11144_CR2","unstructured":"World Health Organization (2025) Breast cancer. WHO Fact Sheets. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/breast-cancer"},{"key":"11144_CR3","doi-asserted-by":"publisher","unstructured":"Eschler J, Bhattacharya A, Pratt W (2018) Designing a reclamation of body and health: cancer survivor tattoos as coping ritual. In: Proceedings of the 2018 CHI Conference on Human Factors in Computing Systems. 1\u201312. https:\/\/doi.org\/10.1145\/3173574.3174084","DOI":"10.1145\/3173574.3174084"},{"issue":"6","key":"11144_CR4","doi-asserted-by":"publisher","first-page":"2081","DOI":"10.1111\/jan.15574","volume":"79","author":"TE Tyner","year":"2023","unstructured":"Tyner TE, Freysteinson WM (2023) The mirror viewing experience of women undergoing a mastectomy: an integrative review. J Adv Nurs 79(6):2081\u20132097. https:\/\/doi.org\/10.1111\/jan.15574","journal-title":"J Adv Nurs"},{"issue":"3","key":"11144_CR5","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.56653","volume":"16","author":"K Shah","year":"2024","unstructured":"Shah K et al (2024) Post-mastectomy pain syndrome: a review article and emerging treatment modalities. Cureus 16(3):e56653. https:\/\/doi.org\/10.7759\/cureus.56653","journal-title":"Cureus"},{"issue":"5","key":"11144_CR6","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1503\/cjs.000716","volume":"59","author":"D Waltho","year":"2016","unstructured":"Waltho D, Rockwell G (2016) Post-breast surgery pain syndrome: establishing a consensus for the definition of post-mastectomy pain syndrome to provide a standardized clinical and research approach - a review of the literature and discussion. Can J Surg 59(5):342\u2013350. https:\/\/doi.org\/10.1503\/cjs.000716","journal-title":"Can J Surg"},{"issue":"3","key":"11144_CR7","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1016\/j.clindermatol.2017.11.002","volume":"36","author":"LP Osborn","year":"2018","unstructured":"Osborn LP, Cohen PR (2018) Emotional healing with unconventional breast tattoos: the role of temporary tattoos in the recovery process after breast carcinoma and mastectomy. Clin Dermatol 36(3):426\u2013429. https:\/\/doi.org\/10.1016\/j.clindermatol.2017.11.002","journal-title":"Clin Dermatol"},{"issue":"4","key":"11144_CR8","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1111\/nuf.12486","volume":"55","author":"V Reid-de Jong","year":"2020","unstructured":"Reid-de Jong V, Bruce A (2020) Mastectomy tattoos: an emerging alternative for reclaiming self. Nurs Forum 55(4):695\u2013702. https:\/\/doi.org\/10.1111\/nuf.12486","journal-title":"Nurs Forum"},{"issue":"2","key":"11144_CR9","doi-asserted-by":"publisher","DOI":"10.1111\/ecc.13214","volume":"29","author":"F Faccio","year":"2020","unstructured":"Faccio F, Mascheroni E, Ionio C, Pravettoni G, Peccatori FA, Pisoni C, Bonassi L (2020) Motherhood during or after breast cancer diagnosis: a qualitative study. Eur J Cancer Care 29(2):e13214. https:\/\/doi.org\/10.1111\/ecc.13214","journal-title":"Eur J Cancer Care"},{"key":"11144_CR10","doi-asserted-by":"publisher","DOI":"10.1177\/0003134820971582","author":"AV McKenna","year":"2020","unstructured":"McKenna AV, Chu QD (2020) Pink ink: postmastectomy tattoos, a potential option for patients. Am Surg. https:\/\/doi.org\/10.1177\/0003134820971582","journal-title":"Am Surg"},{"key":"11144_CR11","volume-title":"The decorated body","author":"R Brain","year":"1979","unstructured":"Brain R (1979) The decorated body. Harper & Row"},{"key":"11144_CR12","volume-title":"The tattoo project: commemorative tattoos, visual culture, and the digital archive","author":"D Davidson","year":"2017","unstructured":"Davidson D (2017) The tattoo project: commemorative tattoos, visual culture, and the digital archive. Canadian Scholars"},{"key":"11144_CR13","unstructured":"Kang M, Jones K (2014) Why do people get tattoos? In: Understanding deviance. Routledge, pp 266\u2013271"},{"key":"11144_CR14","unstructured":"Stutsman A (2016) Inking agency: women\u2019s mastectomy tattoos and emotional healing. Master\u2019s thesis, California State University, Fresno"},{"key":"11144_CR15","volume-title":"Trauma and recovery: the aftermath of violence - from domestic abuse to political terror","author":"JL Herman","year":"2015","unstructured":"Herman JL (2015) Trauma and recovery: the aftermath of violence - from domestic abuse to political terror. Hachette UK"},{"key":"11144_CR16","unstructured":"Reed KS (2018) The breast kind of tattoos: a study of tattoos on mastectomy scars. Master\u2019s thesis, Grand Valley State University. https:\/\/scholarworks.gvsu.edu\/theses\/883"},{"issue":"2","key":"11144_CR17","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1080\/13548506.2022.2057556","volume":"28","author":"KL Moulton","year":"2023","unstructured":"Moulton KL (2023) Exploring tattoo artists\u2019 understanding of decorative non-medical professional tattooing as a method of scar camouflage and decoration. Psychol Health Med 28(2):540\u2013547. https:\/\/doi.org\/10.1080\/13548506.2022.2057556","journal-title":"Psychol Health Med"},{"issue":"1","key":"11144_CR18","doi-asserted-by":"publisher","DOI":"10.1515\/mc-2018-0006","volume":"8","author":"V Koller","year":"2019","unstructured":"Koller V, Bullo S (2019) Fight like a girl\u201d: tattoos as identity constructions for women living with illness. Multimodal Commun 8(1):20180006. https:\/\/doi.org\/10.1515\/mc-2018-0006","journal-title":"Multimodal Commun"},{"key":"11144_CR19","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1037\/10397-003","volume-title":"Meaning reconstruction & the experience of loss","author":"MS Stroebe","year":"2001","unstructured":"Stroebe MS, Schut H (2001) Meaning making in the dual process model of coping with bereavement. Meaning reconstruction & the experience of loss. American Psychological Association, pp 55\u201373. https:\/\/doi.org\/10.1037\/10397-003"},{"issue":"4","key":"11144_CR20","doi-asserted-by":"publisher","first-page":"273","DOI":"10.2190\/OM.61.4.b","volume":"61","author":"M Stroebe","year":"2010","unstructured":"Stroebe M, Schut H (2010) The dual process model of coping with bereavement: a decade on. OMEGA (Westport) 61(4):273\u2013289. https:\/\/doi.org\/10.2190\/OM.61.4.b","journal-title":"OMEGA (Westport)"},{"key":"11144_CR21","doi-asserted-by":"publisher","DOI":"10.1037\/10397-000","author":"RA Neimeyer","year":"2001","unstructured":"Neimeyer RA (2001) Meaning reconstruction and the experience of loss. American Psychological Association. https:\/\/doi.org\/10.1037\/10397-000","journal-title":"American Psychological Association"},{"key":"11144_CR22","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1007\/978-1-4039-1404-0_4","volume-title":"Loss and grief","author":"RA Neimeyer","year":"2002","unstructured":"Neimeyer RA, Anderson A (2002) Meaning reconstruction theory. Loss and grief. Palgrave, pp 45\u201364. https:\/\/doi.org\/10.1007\/978-1-4039-1404-0_4"},{"issue":"5","key":"11144_CR23","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1177\/13591053231215050","volume":"29","author":"TM Newlan","year":"2024","unstructured":"Newlan TM, Greig J (2024) The marked body: exploring experiences of post-mastectomy scarring, body image and change through artistic tattooing. J Health Psychol 29(5):382\u2013395. https:\/\/doi.org\/10.1177\/13591053231215050","journal-title":"J Health Psychol"},{"issue":"3","key":"11144_CR24","doi-asserted-by":"publisher","DOI":"10.1111\/spc3.12438","volume":"13","author":"C Dann","year":"2019","unstructured":"Dann C, Callaghan J (2019) Meaning-making in women\u2019s tattooed bodies. Soc Personal Psychol Compass 13(3):e12438. https:\/\/doi.org\/10.1111\/spc3.12438","journal-title":"Soc Personal Psychol Compass"},{"key":"11144_CR25","unstructured":"Tsang A (2014) My body is a journal, and my tattoos are my story. Exploring the motivations and meanings of tattoos using a multi qualitative-method approach. MMU Psychol J (Dissertations)"},{"issue":"7","key":"11144_CR26","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1001\/jama.2017.0474","volume":"317","author":"D Allen","year":"2017","unstructured":"Allen D (2017) Moving the needle on recovery from breast cancer: the healing role of postmastectomy tattoos. JAMA 317(7):672\u2013674. https:\/\/doi.org\/10.1001\/jama.2017.0474","journal-title":"JAMA"},{"issue":"2","key":"11144_CR27","doi-asserted-by":"publisher","first-page":"503","DOI":"10.3390\/jcm13020503","volume":"13","author":"B B\u0103l\u0103ceanu-Gur\u0103u","year":"2024","unstructured":"B\u0103l\u0103ceanu-Gur\u0103u B, Apostol E, Caraivan M, Ion A, Tatar R, Mihai MM, Popa LG, Gur\u0103u CD, Orzan OA (2024) Cutaneous adverse reactions associated with tattoos and permanent makeup pigments. J Clin Med 13(2):503. https:\/\/doi.org\/10.3390\/jcm13020503","journal-title":"J Clin Med"},{"issue":"2","key":"11144_CR28","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","volume":"3","author":"V Braun","year":"2006","unstructured":"Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77\u2013101. https:\/\/doi.org\/10.1191\/1478088706qp063oa","journal-title":"Qual Res Psychol"},{"issue":"1","key":"11144_CR29","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1177\/1525822X05279903","volume":"18","author":"G Guest","year":"2006","unstructured":"Guest G, Bunce A, Johnson L (2006) How many interviews are enough? An experiment with data saturation and variability. Field Methods 18(1):59\u201382. https:\/\/doi.org\/10.1177\/1525822X05279903","journal-title":"Field Methods"},{"key":"11144_CR30","unstructured":"Ferlay J, Ervik M, Lam F, Laversanne M, Colombet M, Mery L, Pi\u00f1eros M, Znaor A, Soerjomataram I, Bray F (2024) Global cancer observatory: cancer today. International Agency for Research on Cancer, Lyon. https:\/\/gco.iarc.who.int\/media\/globocan\/factsheets\/populations\/900-world-fact-sheet.pdf"},{"key":"11144_CR31","doi-asserted-by":"publisher","unstructured":"Kakilla C (2021) Strengths and weaknesses of semi-structured interviews in qualitative research: a critical essay. Preprints, 2021060491. https:\/\/doi.org\/10.20944\/preprints202106.0491.v1","DOI":"10.20944\/preprints202106.0491.v1"},{"key":"11144_CR32","doi-asserted-by":"publisher","DOI":"10.4324\/9781315638027","volume-title":"Introducing multimodality","author":"C Jewitt","year":"2016","unstructured":"Jewitt C, Bezemer J, O\u2019Halloran K (2016) Introducing multimodality. Routledge. https:\/\/doi.org\/10.4324\/9781315638027"},{"key":"11144_CR33","doi-asserted-by":"publisher","DOI":"10.4324\/9781003099857","volume-title":"Reading images: the grammar of visual design","author":"G Kress","year":"2020","unstructured":"Kress G, Van Leeuwen T (2020) Reading images: the grammar of visual design. Routledge. https:\/\/doi.org\/10.4324\/9781003099857"},{"key":"11144_CR34","volume-title":"Introducing social semiotics","author":"T Van Leeuwen","year":"2005","unstructured":"Van Leeuwen T (2005) Introducing social semiotics. Routledge"},{"issue":"3","key":"11144_CR35","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1348\/014466599162782","volume":"38","author":"R Elliott","year":"1999","unstructured":"Elliott R, Fischer CT, Rennie DL (1999) Evolving guidelines for publication of qualitative research studies in psychology and related fields. Br J Clin Psychol 38(3):215\u2013229. https:\/\/doi.org\/10.1348\/014466599162782","journal-title":"Br J Clin Psychol"},{"key":"11144_CR36","volume-title":"On becoming a person: a therapist\u2019s view of psychotherapy","author":"CR Rogers","year":"1961","unstructured":"Rogers CR (1961) On becoming a person: a therapist\u2019s view of psychotherapy. Houghton Mifflin"},{"issue":"3","key":"11144_CR37","doi-asserted-by":"publisher","DOI":"10.1093\/asjof\/ojab015","volume":"3","author":"SJ Becker","year":"2021","unstructured":"Becker SJ, Cassisi JE (2021) Applications of medical tattooing: a systematic review of patient satisfaction outcomes and emerging trends. Aesthet Surg J Open Forum 3(3):ojab015. https:\/\/doi.org\/10.1093\/asjof\/ojab015","journal-title":"Aesthet Surg J Open Forum"},{"issue":"9","key":"11144_CR38","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-024-08809-4","volume":"32","author":"M Proctor","year":"2024","unstructured":"Proctor M, Cassisi JE, Dvorak RD, Decker V (2024) Medical tattooing as a complementary cosmetic intervention to reduce body-image distress and mental health symptoms in U.S. breast cancer survivors. Support Care Cancer 32(9):600. https:\/\/doi.org\/10.1007\/s00520-024-08809-4","journal-title":"Support Care Cancer"},{"issue":"2","key":"11144_CR39","doi-asserted-by":"publisher","first-page":"105","DOI":"10.4314\/udslj.v16i2.8","volume":"16","author":"W Demeke","year":"2021","unstructured":"Demeke W, Ryan B (2021) Lost in translation: qualitative data collecting and translating challenges in multilingual settings in information systems research. Univ Dar es Salaam Libr J 16(2):105\u2013118. https:\/\/doi.org\/10.4314\/udslj.v16i2.8","journal-title":"Univ Dar es Salaam Libr J"}],"container-title":["Supportive Care in Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00520-026-11144-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00520-026-11144-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00520-026-11144-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T20:02:11Z","timestamp":1790366531000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00520-026-11144-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":39,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["11144"],"URL":"https:\/\/doi.org\/10.1007\/s00520-026-11144-5","relation":{},"ISSN":["0941-4355","1433-7339"],"issn-type":[{"value":"0941-4355","type":"print"},{"value":"1433-7339","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,27]]},"assertion":[{"value":"23 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 August 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 August 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 August 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethics approval was obtained from the Institutional Review Board of The Academic College of Tel Aviv-Yaffo (protocol number 66) in accordance with the Declaration of Helsinki. All participants provided written informed consent prior to participation in the study.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Clinical trial number: not applicable.","order":2,"name":"Ethics","label":"Clinical trial registration","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"902"}}