This patient opted to have the areola tattooed using the "correct color" in the shape of a heart. That way if she decides to change it to a "normal" appearance, she can easily do so at a later date. 
This one was done by Amanda Pepper at Be My Canvas in St Louis, MO both the design elements and the nipples are tattooed.
I was so pleased to receive the following note and photos that I asked the patient if I could use them all:
Dear TJ,
Thank you for the information (and photos) that you post on your website regarding breast reconstruction tattoos. Because of my sister's blogging and her own research, I learned of 3 D nipple tattoos. When I discussed this with my plastic surgeon (twice over the course of about a year and a half), he had no clue what I was referring to. When I showed him the temporary 3 D nipple tatts I had purchased online, he still needed a little more information from me but finally caught on to the idea and showed me how to measure for proper placement. He very honestly told me I should speak with my tattoo artist and get the permanent tattoos done professionally if I went the 3 D route. I did some research and found your website (among others) and am very much appreciate all the photos you have posted along with the process of the procedure. I knew that I wanted something done besides just the nipple and areola complex, but it was very difficult for me to design a tattoo without being able to see how my ideas might work on a breast mound.
My tattoo artist was very willing to work with me and he took a look at your site, also. I was very excited to be getting my dragonfly/flower tattoo done and thought the nipple tatt would finally finish my post-mastectomies healing process but that it would be non-eventful. I was soooooooo wrong! Chip did the nipple tatt 1st and when I got up to look at it, I was blown away. Not only is it beautiful and realistic, but it takes some of the flatness away from the breast mound (mine don't project out very much) and also makes the scar look much less visible. I didn't think that I was letting my scars and my new breasts bother me, but I feel like a new woman status post tattooing!
My plastic surgeon hasn't actually seen my tattoos yet but his entire office staff has and they were all amazed at the difference between my 3 D tatt and the skin grafts and tatt process they do in the office (with 20 years of tattooing experience). The surgeon has since called Chip and inquired into referring patients to his tattoo parlour.
Again, thank you for the service you provide to people who have endured mastectomies and thanks so much for sharing the photos. I have attached my own photos and the credit goes to Chip Beam from www.artifextattoo.com in Vestal, NY.
Mary
Before 
1 day after 
after 5 weeks 
Thank you Mary and Chip for sharing these photos with us!