Nipple-Areola Complex Tattoo Improves Outcomes After Breast Reconstruction

Dermopigmentation of the nipple-areola complex (NAC) is generally understood to be a safe nonsurgical reconstruction technique for people who have undergone breast reconstruction after cancer surgery. The process offers these patients a restoration of psychophysical integrity and represents a final step in breast reconstruction. 

However, the literature on tattooing to rebuild the NAC affects women’s lives; outcomes assessed; and professionals, competence, and training involved in the intervention is unclear. These findings were published in Supportive Care in Cancer.

Therefore, a group of researchers conducted a scoping review using the Joanna Briggs Institute (JBI) methodology on medical tattooing of NAC after surgical treatment of breast cancer. 

A search of Medline, Embase, the Cochrane Library, Clinical Key, Scopus and CINAHL identified 54 records. After removing duplicates and applying inclusion criteria, 13 articles remained for analysis (11 full texts and 2 abstracts). 

Most of the study endpoints focused on patients’ satisfaction with the aesthetic results, with most study results indicating satisfaction as “favorable.” The endpoints evaluated included: 

• The appearance and symmetry of a NAC tattoo made with the 3D-E technique compared with conventional technique in a Japanese facility: 3D-E tattoos were rated significantly higher for appearance and symmetry.
• Patient satisfaction with the NAC tattooing in a UK facility: 70% of 110 responders were satisfied.
• An Italian pilot study evaluated NAC tattoos performed by an advanced practice dermopigmentator: 90% of patients were highly satisfied with the aesthetic results and 97% of patients rated the project as useful or very useful.
• A study of 3D dermopigmentation technique for NAC reconstruction evaluated the satisfaction of the professionals and the patients: overall asthetics and color were rated as good or excellent by 76% and 72% of the professionals, respectively; overall satisfaction and color were rated as good or excellent by 95% and 100% of the patients, respectively.

Despite the positive results, overall quality of evidence was weak, given that most studies had small samples and were not methodologically rigorous. Additionally, most were observational studies based on medical records.  

Furthermore, only 1 study used a validated instrument for outcome measurement. It also was the only study to compare results before and after the tattoo. 

The researchers suggest more robust research is necessary to assess issues such as the best tattooing technique, criteria for the tattoo-only approach, and differences when compared with other procedures. 

Additional research could focus on the relationship between radiotherapy and fading; an evaluation of costs; and who would perform the procedure, such as specially trained nurses or other medical staff, or a professional tattoo artist. 

NAC dermopigmentation should be considered part of the restoring process mental and physical rehabilitation after cancer-related breast reconstruction, not as an “extra” service. Healthcare management should focus on the most feasible ways to provide this service to patients who have undergone demolitive cancer treatments.

“The tattooing of the Nipple-Areola Complex is a safe and satisfactory intervention that can finally restore the integrity of appearance for women who have faced demolitive cancer treatments, with an auspicable improvement of self-perception, anxiety, depression, sexual function, and identity role,” the researchers wrote in conclusion.