DOVER — Mandy Sauler has left her mark on a lot of breast cancer survivors.

The tattoo artist and owner of CosMed Tattoo in Downingtown, Pennsylvania, has been providing the final touches to women who have undergone breast reconstruction by re-creating the look of real nipples.

Ms. Sauler was one of the featured speakers at Dover Downs on Wednesday at the Delaware Breast Cancer Coalition’s 19th annual Breast Cancer Update.

As in years past, the day-long event featured doctors and researchers reporting new treatments and findings, but Ms. Sauler was one of the new additions.

“I grew up in a tattoo shop. My mom is a tattoo artist and I started when I was 14,” she said. “I heard about tattoos being used for cosmetic and medical purposes and I was fascinated by it and have now been doing it for about nine years.”

Ms. Sauler uses special needles, colors and shading techniques to make the tattooed nipple appear three-dimensional.

“When people come to me, they’re usually pretty excited because for them, it the very last step in the process,” Ms. Sauler said. “They’ve already made it through treatment, surgery and reconstruction so what I do, it’s their last stop. So it’s a good experience for them which makes it a good one for me, too.”

But plenty of her clients who come in are a little nervous, especially because many never have considered getting a tattoo.

“For a lot of people they hear tattoos hurt and it’s a fear of the unknown, but I can use a topical anesthetic and everyone always leaves pleased,” Ms. Sauler said.

And for all her clients, Ms. Sauler said a little ink goes a long way.

“A little tattoo might not seem like a big deal to most people but the feeling of completion it gives to patients is bigger than you’d expect. It’s really the final touch to them becoming themselves again.”

A profession in re-creating nipples isn’t a common one so Ms. Sauler provides services through cancer hospitals ranging from Philadelphia to New York City.

Survivors also were featured at the update, including Cheris Reed of New Castle.

“I’m a little nervous to get up in front of all these people,” she said. “But I made a deal with God that if I was able to get through cancer, I’d share my story to help others.”

Ms. Reed was 41 when she was diagnosed with breast cancer at her first routine mammogram.

“At first it was the uncertainty that really got to me,” she said. “I went for the mammogram then they called me back for another test, then another and everything was happening so fast. Usually it takes weeks to get back test results but these only took a day or two so I knew something was probably wrong and it was.”

Before her diagnosis of Stage 1 breast cancer, Ms. Reed never experienced any symptoms and her doctor did not feel a lump at her previous clinical exam.

“It came as a shock because there were absolutely no warning signs and I’ve always been really healthy,” she said.

But after her diagnosis, her team of doctors was very aggressive, having her go through radiation, chemotherapy, surgery and reconstruction.

Although the process was a struggle, Ms. Reed said she couldn’t have done it without the support of her neighbor.

“I had been there for her the year before because she had breast cancer and then she was there for me,” she said.

Although Ms. Reed was able to power through, to set a positive example for her two young children, she did have one breakdown after the initial diagnosis.

“I was one of those women who went to the hair salon every week, always getting something done,” she said. “So losing my hair was one of the hardest things but I looked in the mirror and said ‘you are still beautiful.’ I never even tried to cover it up because it’s nothing to be ashamed of.”

Ms. Reed reached her five-year cancer free mark in August 2014 and as a survivor volunteers as a peer mentor at the Breast Cancer Coalition to support and inspire women undergoing treatment.

“People need to realize breast cancer is no longer a death sentence,” she said. “I want to serve as an example that you can get through this. Survivorship is beautiful and your life will be wonderful again.”

Like Ms. Reed, Holly Thatcher of Townsend was diagnosed with breast cancer through a routine mammogram back in 2007. She also was in her 40s and was diagnosed at Stage 1. Both women’s stories show that mammograms are one of the best ways to detect breast cancer early, in its treatable stations.

But many women find themselves uninsured or under-insured so regular mammograms are not an option for them. That’s why the coalition works with health care providers like Bayhealth and its two cancer centers to provide diagnostic services that may not otherwise be an option.

“We’ve been working with the Breast Cancer Coalition for about 10 years now,” said JoEllen Workman, the manager of Bayhealth’s Cancer Institute. “We do a lot of programs with them, especially in the fall like the Go Pink Health Fair where we provide exams.”

Typically, clinical exams are the easiest to do but mammograms are also available in October to those in need. However, using the technology isn’t cheap so Bayhealth and the coalition work throughout the year to raise funds for screenings and programs.

Last year, Bayhealth’s October Go Pink initiative was able to raise nearly $15,000 for the coalition to continue its services.

For more information about the Delaware Breast Cancer Coalition and what it has to offer, visit debreastcancer.org.