From the Division of Plastic Surgery, Department of Surgery.
Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN.
Ann Plast Surg. 2021 Nov 1;87(5):e86-e91. doi: 10.1097/SAP.0000000000002820.
Nipple-areolar complex (NAC) tattooing remains a simple and safe procedure, which complements breast reconstruction. This study reviews 11 years of NAC tattooing to identify risk factors for tattoo-related complications.
Patients undergoing NAC tattooing from January 2009 to March 2020 were reviewed. Patient information, reconstructive, and tattoo procedural details were analyzed. Tattoo-related breast infections, defined as breast redness requiring antibiotic therapy within 30 days after tattoo, were captured. Patients with reactive breast redness during the first 2 postprocedural days were excluded.
Overall, 539 patients (949 breasts) were included. Implant-based reconstruction (IBR) was performed in 73.6% of breasts (n = 698), whereas 26.4% (n = 251) underwent autologous-based reconstruction (ABR). Acellular-dermal matrix was used in 547 breasts (57.6%). There as a 13.7% (n = 130) of breasts that underwent pretattoo radiation. There was a 65.3% (n = 456) of breasts that underwent subpectoral IBR, whereas 34.7% (n = 242) breasts underwent prepectoral IBR. Tattoo-related infection rate was 2.2% (n = 21 breasts). Mean time to infection was 6.5 ± 5.3 days. There was a 85.7% (n = 18) of infections that occurred in IBR patients, one third occurring in radiated patients. There was a 95.2% (n = 20) of infections that were treated with oral antibiotics only. One explantation was performed after failed intravenous antibiotics. On multivariable analysis, radiation history (odds ratio, 4.1, P = 0.007) and prepectoral IBR (odds ratio, 2.8, P = 0.036) were independent predictors of tattoo-related infection. Among irradiated breasts, breasts with IBR had greater odds of developing tattoo-related infection versus breasts with ABR (P = 0.025).
Although tattoo-related infections were uncommon, previous radiation and prepectoral IBR were both found to be independent predictors of tattoo-related breast infection. There is a role for preprocedural prophylactic antibiotics in these patients to mitigate infectious risk.
乳头乳晕复合体（Nipple-areolar complex，NAC）纹身仍然是一种简单且安全的操作，可与乳房重建相辅相成。本研究回顾了 11 年来的 NAC 纹身情况，以确定与纹身相关并发症的风险因素。
回顾 2009 年 1 月至 2020 年 3 月期间接受 NAC 纹身的患者。分析患者信息、重建和纹身程序细节。记录纹身相关乳房感染的情况，定义为纹身 30 天内需要抗生素治疗的乳房发红。排除术后前两天出现反应性乳房发红的患者。
共有 539 名患者（949 只乳房）纳入研究。基于植入物的重建（implant-based reconstruction，IBR）在 73.6%（n=698）的乳房中进行，而基于自体组织的重建（autologous-based reconstruction，ABR）在 26.4%（n=251）的乳房中进行。547 只乳房（57.6%）使用了脱细胞真皮基质。13.7%（n=130）的乳房接受了术前放疗。65.3%（n=456）的乳房进行了胸肌下 IBR，而 34.7%（n=242）的乳房进行了胸肌前 IBR。纹身相关感染率为 2.2%（n=21 只乳房）。感染的平均时间为 6.5±5.3 天。IBR 患者中 85.7%（n=18）出现感染，三分之一的感染发生在接受放疗的患者中。95.2%（n=20）的感染仅通过口服抗生素治疗。在静脉注射抗生素治疗失败后，有一只乳房进行了乳房切除术。多变量分析显示，放疗史（比值比，4.1，P=0.007）和胸肌前 IBR（比值比，2.8，P=0.036）是纹身相关感染的独立预测因素。在接受放疗的乳房中，IBR 乳房比 ABR 乳房发生纹身相关感染的可能性更高（P=0.025）。
尽管纹身相关感染并不常见，但既往放疗和胸肌前 IBR 均被发现是纹身相关乳房感染的独立预测因素。对于这些患者，术前预防性使用抗生素可以降低感染风险。
