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  • Allen's work with mastectomy patients can be transforming in large...

    Stacey Wescott / Chicago Tribune

    Allen's work with mastectomy patients can be transforming in large and small ways. Though Tsai, who calls herself "kind of a conservative Midwestern woman" had never had a tattoo before her mastectomy, she is now adding additional artwork to her back.

  • Tsai, left, hugs patient Lorna Mackie. "Being able to do...

    Stacey Wescott / Chicago Tribune

    Tsai, left, hugs patient Lorna Mackie. "Being able to do something that has helped people and inspired people," Tsai says, "is just existentially epic; it's really cool."

  • Tattoo artist David Allen applies shading to the post-mastectomy tattoos...

    Stacey Wescott / Chicago Tribune

    Tattoo artist David Allen applies shading to the post-mastectomy tattoos he created for client Michaela Tsai. "It has been very transformative," she says, "turning something that was a reminder of disease, pain and disfigurement into something really empowering, artistic and beautiful."

  • Developing greater empathy while working with mastectomy patients has helped...

    Stacey Wescott / Chicago Tribune

    Developing greater empathy while working with mastectomy patients has helped Allen explore his own creativity.  He spends part of each day painting, in hopes of one day showing his work. "I started to paint because I sort of got rid of myself," he says.

  • Tsai says her post-mastectomy tattoos helped her reclaim something she...

    Stacey Wescott / Chicago Tribune

    Tsai says her post-mastectomy tattoos helped her reclaim something she had lost. The day after her first session with Allen, she said, "for the first time, I looked in the mirror and thought, 'Oh, wow, that's me. That's so cool.'"

  • Allen's work requires care, concentration and an openness to the...

    Stacey Wescott / Chicago Tribune

    Allen's work requires care, concentration and an openness to the emotional journey the women with breast cancer are traveling.  "Their stories are absolutely astounding," he says.

  • Allen works on the botanical tattoo over Tsai's chest. "I love...

    Stacey Wescott / Chicago Tribune

    Allen works on the botanical tattoo over Tsai's chest. "I love it," says Tsai, "and now it's like a sense of pride that I did this. I know that I'm different, but it's different in a good way now."

  • Tsai, right, listens to patient Lorna Mackie. Tsai's experience as an...

    Stacey Wescott / Chicago Tribune

    Tsai, right, listens to patient Lorna Mackie. Tsai's experience as an oncologist made her own decision to get a mastectomy simpler, she says.  "It didn't feel very brave," she says. "As a mother, I felt, 'Clearly I just have to do this.'"

  • "It's an immediate and intimate connection you have with David...

    Stacey Wescott / Chicago Tribune

    "It's an immediate and intimate connection you have with David when he's doing his work," says Tsai. "I'm just lying there having this done, and I'm talking to him like he's a good friend I've known my whole life."

  • As a child, Allen says, "I would just draw what...

    Stacey Wescott / Chicago Tribune

    As a child, Allen says, "I would just draw what I saw, anything. And it's just doing it over and over until you are good at it." Now, he applies that artistry to tattoos and to the paintings he creates at home.

  • Tsai,  shown in her office at Minnesota Oncology in Minneapolis, specializes...

    Stacey Wescott / Chicago Tribune

    Tsai,  shown in her office at Minnesota Oncology in Minneapolis, specializes in breast cancer treatment. Her decision to get a post-mastectomy tattoo was inspired by a patient's tattoo. "She carried herself differently," says Tsai, "and she had pride. And I thought that was great."

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David Allen rests his forearm on the bare back of his client, a record producer, and applies the needle of a nearly silent tattoo machine to the stencil of a cicada on the man’s skin. He works methodically around one outstretched wing, intensely focused, until the client is ready for a break, fresh red welts rising along the lines of ink.

“He doesn’t handle pain well,” Allen comments. “He doesn’t know that. You have to develop an instinct for pain. You learn it, and it makes your job easier.

“Men,” he adds, “don’t handle pain as well as women.”

Scientific research says that’s not strictly true. But Allen speaks from unique experience: Not only has he spent years sticking needles into both men and women, but over the past four years, he has guided hundreds of women through one of the most traumatic experiences the fickle world inflicts — recovery from breast cancer.

A sought-after tattoo artist, Allen works in a quiet, second-floor loft with no sign on the door, for select clients who wait six months or more to secure an appointment. Some of his clients are well-known — Lady Gaga got a David Allen tattoo earlier this year. But about five times each month, Allen spends a day or two constructing elaborate, delicately shaded tattoos on the scarred, imperfect breasts of women who have undergone mastectomies to rid their bodies of life-threatening cancer. More than that: He lets them cry, and cries with them. He listens to them talk about husbands who don’t get it, or do. His hands are sometimes the only other human hands that have touched the places where they hurt.

He is well aware of the silly overkill of overt tattoo culture. But for every Cubs logo on the shoulder of a freshly minted Wrigleyville bro, there is a tattoo that points the way to the kinds of unimaginable things that humans endure. “People,” he says, “need to leave a mark.” And Allen is a willing conduit for the secret histories of others, a savant for pain who has learned just where to place the needle.

“I was raised by a single mom,” Allen says, as a way of explaining why he is almost painfully attuned to the female frequency. “So I really connect to women better than men.” Allen’s grandparents helped raise him in Indiana, and his grandfather supplied the male yang to his mother’s yin. The family was deeply religious, a life strictly organized around faith and a well-defined heaven and hell. “You live in a world of guilt,” Allen says, “and then you get older, and you don’t want that anymore.” Eventually, religion fell by the way, but the sense of right and wrong stuck. “I’m very liberal,” he says, “but also I have this old man in my head. And I still do believe in God.”

In school, he was “a kid who had to draw while I was listening.” He’s a classic ADHD sufferer, with hands that need to move, but there was something more to his artwork. “I couldn’t not draw,” he says. “I would just draw what I saw, anything. And it’s just doing it over and over until you are good at it.”

In high school, he began to translate his art into website design and eventually transitioned to a job in Austin, Texas, as an art director at HM Magazine, a music magazine. “I loved the idea of doing it,” he says, “but it became a desk job for me after a while.”

He returned to the Chicago area to be close to his family and decided to learn tattooing. “I saw I could make more money and set my own schedule,” he says. And it suited his temperament: “Tattooing has helped me, because I can now turn on the hyper-focused part of ADHD and use that. I’ve learned to control it.”

Allen’s artistry and intuitive way with people quickly gained him a following in the tattoo world. Clients trusted him — including one who told him about her battle with breast cancer and asked him to compose a tattoo that would disguise the scars from her mastectomy.

“I was intimidated to do it at first,” he says. “I was scared because the skin has been radiated and cut up, and scar tissue is different than regular skin. But I had this one client who insisted I do it.”

He had seen his share of odd situations: “I have clients where I tattoo the man, his wife and then his mistress. It’s not my place to judge.” But the idea of attaching his work to something so visceral stopped him. “This was heavy, the gravity of it.”

Allen’s work requires care, concentration and an openness to the emotional journey the women with breast cancer are traveling. “Their stories are absolutely astounding,” he says.

The idea began to take hold, though. “I began to see that people haven’t done this with grace, really,” Allen says. “My background is design, and I can look and see how to pull the eye the way we want it to go, create a curved line where we need one.” Mastectomy tattoos had begun to catch on with breast cancer survivors, from a tattoo intended as a trompe l’oeil nipple to more elaborate versions intended to cover scars.

Allen, moved by his client’s trust, wanted to create the tattoos not as coverings, but as art. “You realize that your work is not as good as it could be unless you connect it to the person. The connection with the person is more important. The work itself, I can figure out.”

Photos of that first mastectomy tattoo, a magnolia blossom cupping the breast, were posted online, where they brought more requests from breast cancer survivors. Allen began accepting those requests — and slowly realizing that something had shifted.

“Their stories are absolutely astounding,” he says. “Some of them want to cover the scars. Some want to feel sexual again or just to take control of a situation they have had no control over for four or five years. Some of the men are great. A lot are not.”

He saw women who had battled through cancer even as spouses left them, or while also caring for sick children. Emails requesting his services arrived, women walked through his door, and the stories poured out, rich in agonizing detail, loaded with fear, sorrow and resilience.

“Men pride themselves on strength,” he says, “but women just have it. I’ve never seen a strength like that. It’s incredible to watch the range women have. I hear guys complain, ‘Oh, they’re all over the map!’ But it’s so beautiful. Women do so much.”

Michaela Tsai’s story began with her father’s prostate cancer, which revealed the presence of the BRCA2 gene in her dad, her two aunts and herself. “I was 36 at the time,” she says. “I had never had a mammogram.” She was the mother of two children, ages 1 and 3, and her husband had a cardiac condition that left her uncertain about his health. When her first mammogram came back abnormal and follow-up tests were unclear, no one needed to explain the implications — she is an oncologist in Minneapolis who specializes in breast cancer. “I knew it was more a question of when I get breast cancer, not if I get breast cancer,” Tsai says. “So I just wanted to go ahead and have surgery.” She scheduled herself for a mastectomy.

“It didn’t feel very brave,” she says. “As a mother, I felt, ‘Clearly, I just have to do this.’ It hit me a year or two years later that it was a pretty momentous thing to have done, but I have no regrets.”

Still, there were moments when coping with a post-mastectomy body wasn’t easy. “My self-identity has not been tied up in my body physically. But there are times when you look in the mirror, and it’s like, you know, ‘Gosh this is different; this is not normal.’ When you take your kids to the pool, and you’re like, ‘I have to go in the changing room because otherwise people will see this and have questions.’ You’re conscious of being different.”

Tsai had heard of mastectomy tattoos but hadn’t considered one for herself. “I had seen women do the nipple tattooing, and they don’t look normal. But I had one patient, a beautiful woman from Africa, and she had done just a simple tattoo. She showed me, and I thought it was pretty cool. She had had a very hard time, and she was transformed after that. She carried herself differently, and she had pride. And I thought that was great.”

Inspired, Tsai started with an online search. “I immediately came upon some of the work David had done and thought, ‘That’s what I want to do.’

“My husband was a little bit surprised,” she says. “I’m kind of a conservative Midwestern woman, and now I’m going to go to Chicago to see this guy and get a tattoo? But once I showed him pictures, and he saw what David was doing, he was like, ‘Yes, if this is what you want, you should do it.'”

“Sometimes people can feel really defined by being a survivor.” says Michaela’s husband, Albert Tsai. “But with these tattoos, she was making something beautiful, instead of something to be afraid or ashamed of.”

Tsai’s tattoo took about 12 hours over four days to complete. “It’s an immediate and intimate connection you have with David when he’s doing his work,” she says. “I’m just lying there having this done, and I’m talking to him like he’s a good friend I’ve known my whole life. It was almost like a therapy session.”

“The healing that needs to take place,” Allen says, “is not just physical. I had to dive into that idea because of the mastectomy tattoos. It changed my life.

“I have to constantly remove myself. I couldn’t do those tattoos unless I could sort of get rid of myself. You listen. And you realize many of these women have not had anyone to listen to them for years.”

Allen is keenly aware of living up to the trust placed in him. So he talks the women through fear, listens to their heartbreak, follows the rhythm of their breathing, so that he can track the pain.

“The chest post-surgery is numb,” says Tsai, “but you can still feel the tattoo needle. After the first day, I felt emotionally drained. But the next day, for the first time, I looked in the mirror and thought, ‘Oh, wow, that’s me. That’s so cool.'”

What she saw was an asymmetrical grouping of flowers based on the classical illustrations of Pierre-Joseph Redoute, the inspiration for much of Allen’s mastectomy work. “I usually do floral,” he says, “because the scars are so rigid, we need something organic to soften that and create curved lines. I usually do black and gray because it blends in with the skin. I want to create something that is connected to the body, not something that’s going to be like a sticker.”

Tsai’s tattoos, which have been widely seen in online photos, are arrestingly lovely. The flowers seem to cradle her body, giving the composition a painterly quality. There is none of the aggression conveyed in many tattoos, but rather a sense of delicacy and fragility.

“I love it,” says Tsai, “and now it’s like a sense of pride that I did this. I know that I’m different, but it’s different in a good way now.” Though she is somewhat private about her tattoos, she knows that the photos get reactions and has even had patients mention that they were inspired by seeing the tattoos online — unaware that it was their doctor in the photos they had seen.

“Going into oncology,” she says, “you know that many of your patients aren’t going to make it through. So you hold on to the ones who do make it and the positive moments. Being able to do something that has helped people and inspired people is just existentially epic; it’s really cool.”

“We live in a world where all of our choices are limited,” Allen says. “This is control. It’s taking back control at a really basic level.

“It would be easier for me to not do it, because it’s heavy. But I feel lucky. I don’t feel worthy of it, but I have it. It’s overwhelming.”

The number of mastectomy patients on his schedule continues to grow, in spite of costs that range between $800 and $2,000, and Allen continues to accommodate them. “Watching it progress, it’s really beautiful,” he says. “I get emails from people every day who are just glad that there’s an option here. The message to me is one of acceptance. I want to push it as far as I can.”

Doing the mastectomy work, he says, has also pushed his art in new directions: He now spends part of each day painting, in hopes of one day showing his work in a gallery. “I started to paint because I sort of got rid of myself,” he says. “I had all these skills to get to know people, and I found I can use them on myself. So I paint every night. And it’s going well. Just toiling away.”

“He may be professionally known as a tattoo artist,” says Art Expo’s Tony Karman, a friend. “But the painting that he is doing outside of his tattoo work is just as important to him and is revealing of his talent in a whole new way. It’s an old adage, but he’s real, he’s very genuine, and from his heart he’s a good person. And it’s easy to get behind someone like that.”

Allen also talks about mastectomy tattooing to groups, including to doctors and other medical professionals who deal with cancer patients. His topic? Empathy. “When you tattoo,” he says, “you can’t see how deep the needle is going, so you have to tell by the vibration of the skin whether you are in the right layer, in the right place. In the same way, I have to check myself every day to make sure I’m accurate with my empathy.”

And though, in the end, a tattoo is just an image on skin, Allen says the story underneath is the reason he keeps doing it. “I don’t think it’s about the final product,” he says, “it’s about the process. If the product is the focus, you’re skipping the person. I’m good at my craft, and I get paid a lot for it. No matter what, I know I’m going to give you a great tattoo. But if I understand the person, the final product just gets in line.”

He stops, feeling for something deeper. “You know what?” he says. “I don’t really care about tattoos. It’s just that they’re connected to people. They matter. They are why you’re here.”

cdampier@chicagotribune.com

Twitter @csdampier

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