Tattooing of the nipple-areola complex: review of outcome in 40 patients.

Reconstruction of a pigmented nipple-areola complex (NAC) is one of the final steps in rehabilitating patients following mastectomy. We report the results of 40 consecutive patients who had NAC tattooing done by the same surgeon. Assessments were made both subjectively using a questionnaire, and objectively by using a computer software programme (Adobe Photoshop) to analyse the colour of the NACs. Follow up ranged between six and 24 months (mean 14 months). One patient suffered an infection, and was the only one to need repeat tattooing in our series. Thirty-seven patients (92%) reported some colour fading which ranged between 5% and 80% (mean 32%). A grade of good or very good was given by 33 patients (82%) for colour match, by 36 patients (90%) for over all satisfaction, and by 34 patients (85%) for enhancement in body image. An analysis of the colours of the tattooed and unoperated NACs by the software programme showed that they were similar to a value that ranged from 78% to 97% (mean 91%). Tattooing is a simple and safe procedure, and despite some colour asymmetry it still has a high satisfaction rate. It significantly improves patient's perception of body image. An objective assessment of tattooing using a computer software programme can be a useful tool in reviewing the outcome. Video clips (1-5) are included with the paper for demonstration of the tattooing technique (re-arranged from the video presented with the paper at BAPS).