Factors influencing final rendering in areola tattoo reconstruction: a statistical analysis


Irene Laura Lusetti https://orcid.org/0000-0002-2564-9610
Caterina Marra https://orcid.org/0000-0002-3511-8127
Lucrezia Pacchioni https://orcid.org/0000-0002-0837-7844
Giorgio De Santis https://orcid.org/0000-0002-6717-5767


NAC reconstruction, areola reconstruction, areola tattoo, breast reconstruction, radiotherapy


Background and aim: Reconstruction of the nipple-areola complex announces the end of breast reconstruction process, sometimes difficult to live for the patient, and significantly improves the perception of body image. In literature there are no studies addressing the possible influencing factors of the final rendering of areola reconstruction with tattoo. The aim of the present study was to evaluate all the factors which could influence the yield and the final result of the nipple areola complex pigmentation.

Methods: 97 patients who underwent areolar tattooing between January 2018 and February 2020 were retrospectively reviewed. Breast reconstruction timing and personal history, as well as surgical details were recorded.

Results: Mean age was 52 years old (range 29-71), almost the totality of cases was women including even 2 men (one with Poland syndrome and one post mastectomy). 27 patients needed bilateral tattooing. 22 had history of adjuvant radiotherapy, 16 received neoadjuvant chemotherapy and 4 adjuvant chemotherapy. In the logistic regression analysis, radiotherapy resulted a risk factor for retattooing (p<0.05) while the autologous breast reconstruction resulted a protective factor for retattooing. Neo- and adjuvant chemotherapy were not statistically significant.

Conclusions: Tissue thickness, sex, reconstructive technique and history of radiotherapy could influence the final result in areola reconstruction with tattoo, and must be taken into account to obtain the best result, knowing when the pigmentation has to be repeated.  


Download data is not yet available.
Abstract 0 |


1. Riot S, Devinck F, Aljudaibi N, Duquennoy-Martinot V, Guerreschi P. Tatouage de la plaque aréolo-mammelonnaire en reconstruction mammaire : note technique. Ann Chir Plast Esthét. 2016;61(2):141-144. doi:10.1016/j.anplas.2015.11.005
2. Goh SCJ, Martin NA, Pandya AN, Cutress RI. Patient satisfaction following nipple-areolar complex reconstruction and tattooing. J Plast Reconstr Aesthet Surg. 2011;64(3):360-363. doi:10.1016/j.bjps.2010.05.010
3. Harcourt D, Russell C, Hughes J, White P, Nduka C, Smith R. Patient satisfaction in relation to nipple reconstruction: The importance of information provision. J Plast Reconstr Aesthet Surg. 2011;64(4):494-499. doi:10.1016/j.bjps.2010.06.008
4. Farhadi J, Maksvytyte GK, Schaefer DJ, Pierer G, Scheufler O. Reconstruction of the nipple-areola complex: an update. J Plast Reconstr Aesthet Surg. 2006;59(1):40-53. doi:10.1016/j.bjps.2005.08.006
5. Nahabedian MY. Nipple Reconstruction. Clin Plast Surg. 2007;34(1):131-137. doi:10.1016/j.cps.2006.11.009
6. Uhlmann NR, Martins MM, Piato S. 3D areola dermopigmentation (nipple‐areola complex). Breast J. 2019;25(6):1214-1221. doi:10.1111/tbj.13427
7. Cha HG, Kwon JG, Kim EK. Simultaneous Nipple–Areola Complex Reconstruction Technique: Combination Nipple Sharing and Tattooing. Aesthetic Plast Surg. 2019;43(1):76-82. doi:10.1007/s00266-018-1247-2
8. Bykowski MR, Emelife PI, Emelife NN, Chen W, Panetta NJ, de la Cruz C. Nipple–areola complex reconstruction improves psychosocial and sexual well-being in women treated for breast cancer. J Plast Reconstr Aesthet Surg. 2017;70(2):209-214. doi:10.1016/j.bjps.2016.10.009
9. Nimboriboonporn A, Chuthapisith S. Nipple-areola complex reconstruction. Gland Surg. 2014;3(1):8.
10. Cha HG, Kwon JG, Kim EK, Lee HJ. Tattoo-only nipple-areola complex reconstruction: Another option for plastic surgeons. J Plast Reconstr Aesthet Surg. 2020;73(4):696-702. doi:10.1016/j.bjps.2019.11.011
11. Lee HC, Eom JS, Kim EK, Lee TJ. Does the Sequence of Tattooing and Nipple Reconstruction Affect Nipple Projection?: Ann Plast Surg. 2017;79(5):430-432. doi:10.1097/SAP.0000000000001122
12. Nota circolare sui tatuaggi con finalità medica; chiarimenti in merito alla pigmentazione dell’areola-capezzolo. 2019
13. Coltman CE, Steele JR, McGhee DE. Effect of aging on breast skin thickness and elasticity: implications for breast support. Skin Res Technol. 2017;23(3):303-311. doi:10.1111/srt.12335
14. Nedelec B, Forget NJ, Hurtubise T, et al. Skin characteristics: normative data for elasticity, erythema, melanin, and thickness at 16 different anatomical locations. Skin Res Technol. 2016;22(3):263-275. doi:10.1111/srt.12256
15. Yarnold J, Vozenin Brotons M-C. Pathogenetic mechanisms in radiation fibrosis. Radiother Oncol. 2010;97(1):149-161. doi:10.1016/j.radonc.2010.09.002
16. Firooz A, Rajabi-Estarabadi A, Zartab H, Pazhohi N, Fanian F, Janani L. The influence of gender and age on the thickness and echo-density of skin. Skin Res Technol. 2017;23(1):13-20. doi:10.1111/srt.12294
17. Vadodaria SJ, Vadodaria BS. Tattooing for the management of white patches. Ann Plast Surg 1989;23:81–3.

Most read articles by the same author(s)