Aesthetic Plastic Surgery

, Volume 42, Issue 3, pp 656–661 | Cite as

Color Change After Paramedical Pigmentation of the Nipple–Areola Complex

  • Shoichi TomitaEmail author
  • Katsuya Mori
  • Takeshi Miyawaki
Original Article Breast Surgery



Reconstruction of the nipple–areola complex is the final process in breast reconstruction. Local flaps and paramedical pigmentation is one of the major procedures for this. However, fading after paramedical pigmentation leads to a color difference between the selected pigment and its color in the skin. The aim of this study is to make a proposition in color choice of paramedical pigmentation for nipple–areola complex.


Our research focused on investigating the color changes over time after unilateral nipple–areola complex reconstruction using paramedical pigmentation in 25 patients to propose suitable color selections. We measured the color by spectrometer and conducted comparisons using the hue, saturation, and value (HSV) color space and the color space defined by the Commission International de L’eclairage based on one channel for luminance (lightness) (L) and two color channels (a and b) (L*a*b*).


A comparison of the hue, value, and saturation of the reconstructed areola compared to the normal areolae was conducted using HSV color space; the value and saturation were satisfactory after 3 months and beyond, but the reconstructed areola tended to have stronger red hues. The color difference (ΔE00) calculated in L*a*b* color space showed slow fading after the scab was peeled off.


This result indicates that a color with less redness and more yellowness, particularly 4–5 degrees of yellowness on the color wheel, than the normal side is the most appropriate color selection for this technique.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Breast reconstruction Nipple–areola reconstruction Paramedical pigmentation Permanent makeup Tattoo 



We would like to thank Editage ( for English language editing and Publication Support.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards and approved by the ethical committee of the Jikei University School of Medicine (8218). Informed consent was obtained from all patients.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2017

Authors and Affiliations

  • Shoichi Tomita
    • 1
    Email author
  • Katsuya Mori
    • 1
    • 2
  • Takeshi Miyawaki
    • 1
  1. 1.Department of Plastic and Reconstructive SurgeryThe Jikei University School of MedicineTokyoJapan
  2. 2.Shibuya Mori ClinicTokyoJapan

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