Skip to main content

3D Nipple–Areolar Tattoo: It’s Technique, Outcomes, and Utilization

Aesthetic Plastic Surgery volume 45, pages 453–458 (2021)Cite this article

Abstract

Background

Three-dimensional (3D) nipple–areolar tattoo is a novel approach to nipple–areolar complex reconstruction for which little data exist. Our aim was to evaluate 3D nipple–areolar tattoo outcomes and investigate if patient factors, payer status, surgeries, or therapies affect tattoo utilization.

Methods

Patients pursuing skin-sparing (SSM) or attempted nipple-sparing mastectomy (NSM) with breast reconstruction from 2008 to 2019 were reviewed. Outcomes included frequency of 3D tattoo, post-procedure complications (infections, or other local adverse sequelae), and rates, indications, and timing of revisions. Patient factors, payer status, surgeries, and adjuvant therapies underwent univariate analysis comparing rates of 3D tattoo and revisions.

Results

A total of 191 patients were identified; median follow-up was 4 years. The majority of patients were white (165, 86%), married (146, 76%), and post-menopausal (97, 51%), with private insurance (156, 81%). Surgeries included SSM (172, 90%) or attempted NSM (19, 10%) with implant (154, 81%) or autologous reconstruction (37, 19%). Sixty-two patients (32%) underwent 3D nipple–areolar tattooing. No post-procedure complications occurred. After tattooing, 20 patients (32%) pursued revisions, the majority due to color fading (12, 60%). Average time from tattoo to completion of revisions was 5.6 months. Patients undergoing autologous reconstruction had a higher rate of 3D tattooing (p < 0.001). Adjuvant radiation led to a higher rate of revisions (p = 0.02). Patient factors, payer status, index mastectomy, and chemotherapy did not significantly affect rates of 3D tattooing or revisions.

Conclusions

3D nipple–areolar tattoo utilization is likely unaffected by age, marriage, menopause, or payer status. Radiotherapy and color fading can lead to more revisions.

Level of Evidence IV

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 www.springer.com/00266.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Kummerow KL, Du L, Penson DF, Shyr Y, Hooks MA (2015) Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg 150(1):9–16

    Article  Google Scholar 

  2. Albornoz CR, Matros E, Lee CN, Hudis CA, Pusic AL, Elkin E, Bach PB, Cordeiro PG, Morrow M (2015) Bilateral mastectomy versus breast-conserving surgery for early stage breast cancer: the role of breast reconstruction. Plast Reconstr Surg 135(6):1518

    CAS  Article  Google Scholar 

  3. Joslyn SA (2005) Patterns of care for immediate and early delayed breast reconstruction following mastectomy. Plast Reconstr Surg 115(5):1289–1296

    CAS  Article  Google Scholar 

  4. Alderman AK, McMahon L, Wilkins EG (2003) The national utilization of immediate and early delayed breast reconstruction and the effect of sociodemographic factors. Plast Reconstr Surg 111(2):695–705

    Article  Google Scholar 

  5. Ilonzo N, Tsang A, Tsantes S, Estabrook A, Ma AM (2017) Breast reconstruction after mastectomy: a ten-year analysis of trends and immediate postoperative outcomes. The Breast 32:7–12

    Article  Google Scholar 

  6. Azouz S, Swanson M, Omarkhil M, Rebecca A (2020) A nipple-areola stencil for three-dimensional tattooing: nipple by number. Plast Reconstr Surg 145(1):38–42

    CAS  Article  Google Scholar 

  7. Rees TD (1975) Reconstruction of the breast areola by intradermal tattooing and transfer: case report. Plast Reconstr Surg 55(5):620–622

    CAS  Article  Google Scholar 

  8. Becker H (1986) The use of intradermal tattoo to enhance the final result of nipple-areola reconstruction. Plast Reconstr Surg 77(4):673–676

    CAS  Article  Google Scholar 

  9. Halvorson EG, Cormican M, West ME, Myers V (2014) Three-dimensional nipple-areola tattooing: a new technique with superior results. Plast Reconstr Surg 133(5):1073–1075

    CAS  Article  Google Scholar 

  10. Butler PD, Plana NM, Hastings AL (2019) Finishing touches: expanding access to nipple-areola tattooing as a component of postmastectomy breast reconstruction. Plast Reconstr Surg Global Open 7(11):2558

    Article  Google Scholar 

  11. Cha HG, Kwon JG, Kim EK, Lee HJ (2020) Tattoo-only nipple-areola complex reconstruction: another option for plastic surgeons. J Plast Reconstr Aesthet Surg 73(4):696–702

    Article  Google Scholar 

  12. Sisti A, Grimaldi L, Tassinari J, Cuomo R, Fortezza L, Bocchiotti MA, Roviello F, D'Aniello C, Nisi G (2016) Nipple-areola complex reconstruction techniques: a literature review. Eur J Surg Oncol (EJSO) 42(4):441–465

    CAS  Article  Google Scholar 

  13. Spear SL, Arias J (1995) Long-term experience with nipple-areola tattooing. Ann Plast Surg 35(3):232–236

    CAS  Article  Google Scholar 

  14. El-Ali K, Dalal M, Kat CC (2006) Tattooing of the nipple-areola complex: review of outcome in 40 patients. J Plast Reconstr Aesthet Surg 59(10):1052–1057

    CAS  Article  Google Scholar 

  15. Didier F, Arnaboldi P, Gandini S, Maldifassi A, Goldhirsch A, Radice D, Minotti I, Ballardini B, Luini A, Santillo B, Rietjens M (2012) Why do women accept to undergo a nipple sparing mastectomy or to reconstruct the nipple areola complex when nipple sparing mastectomy is not possible? Breast Cancer Res Treat 132(3):1177–1184

    CAS  Article  Google Scholar 

  16. Coopey SB, Tang R, Lei L, Freer PE, Kansal K, Colwell AS, Gadd MA, Specht MC, Austen WG, Smith BL (2013) Increasing eligibility for nipple-sparing mastectomy. Ann Surg Oncol 20(10):3218–3222

    Article  Google Scholar 

  17. Smith BL, Tang R, Rai U, Plichta JK, Colwell AS, Gadd MA, Specht MC, Austen WG Jr, Coopey SB (2017) Oncologic safety of nipple-sparing mastectomy in women with breast cancer. J Am Coll Surg 225(3):361–365

    Article  Google Scholar 

  18. Valero MG, Muhsen S, Moo TA, Zabor EC, Stempel M, Pusic A, Gemignani ML, Morrow M, Sacchini VS (2020) Increase in utilization of nipple-sparing mastectomy for breast cancer: indications, complications, and oncologic outcomes. Ann Surg Oncol 27(2):344–351

    Article  Google Scholar 

  19. Mastroianni M, Lin AM, Smith BL, Austen WG, Colwell AS (2016) Nipple loss following nipple-sparing mastectomy. Plast Reconstr Surg 138(1):24e–30e

    CAS  Article  Google Scholar 

  20. Momoh AO, Colakoglu S, de Blacam C, Yueh JH, Lin SJ, Tobias AM, Lee BT (2012) The impact of nipple reconstruction on patient satisfaction in breast reconstruction. Ann Plast Surg 69(4):389–393

    CAS  Article  Google Scholar 

  21. Baker C, Johnson N, Nelson J, Homer L, Walts D, Waldorf K, Boardman K (2002) Perspective on reconstruction after mastectomy. Am J Surg 183(5):562–565

    Article  Google Scholar 

  22. Duggal CS, Metcalfe D, Sackeyfio R, Carlson GW, Losken A (2013) Patient motivations for choosing postmastectomy breast reconstruction. Ann Plast Surg 70(5):574–580

    CAS  Article  Google Scholar 

  23. Goh SC, Martin NA, Pandya AN, Cutress RI (2011) Patient satisfaction following nipple-areolar complex reconstruction and tattooing. J Plast Reconstr Aesthet Surg 64(3):360–363

    CAS  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Phoenix, AZ, USA

    Jacob B. Hammond & Eric T. Siebeneck

  2. Division of Plastic and Reconstructive Surgery, Mayo Clinic, Phoenix, AZ, USA

    Chad M. Teven, Robert W. Bernard, Heather D. Lucas, William J. Casey, Erwin A. Kruger & Alanna M. Rebecca

Authors
  1. Jacob B. Hammond
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chad M. Teven
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert W. Bernard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Heather D. Lucas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. William J. Casey
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eric T. Siebeneck
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Erwin A. Kruger
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alanna M. Rebecca
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alanna M. Rebecca.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Human Rights Statement

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.

Informed Consent

For this type of study, formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hammond, J.B., Teven, C.M., Bernard, R.W. et al. 3D Nipple–Areolar Tattoo: It’s Technique, Outcomes, and Utilization. Aesth Plast Surg 45, 453–458 (2021). https://doi.org/10.1007/s00266-020-01967-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-020-01967-w

Keywords

  • Nipple–areolar tattoo
  • Nipple reconstruction
  • Three-dimensional tattoo
  • Outcomes
  • Revisions