Tattoo-only nipple-areola complex reconstruction: Another option for plastic surgeons

Summary Background Total breast reconstruction involves a long process consisting of mastectomy, breast reconstruction, and adjuvant therapy. For various reasons, some patients refuse the final step of nipple-areola reconstruction. Some patients have potential risk factors for poor outcome after undergoing conventional techniques. We have performed tattoo-only nipple-areola complex reconstruction in these situations and accomplished satisfactory results for both patients and surgeons. Methods Ninety-five patients who underwent nipple-areola complex reconstruction between October 2017 and June 2018 were included. We retrospectively evaluated the breast reconstruction timing and type, history of a secondary breast procedure or other operations, history of adjuvant therapy, reasons for performing a tattoo-only procedure, and average operative time. Overall patient satisfaction was assessed and compared. Results Twenty patients (21%) underwent tattoo-only nipple-areola complex reconstruction. The main reasons for performing the tattoo-only technique were patient reluctance to undergo another operation, thin and/or tight breast skin in patients with implant-based reconstruction, radiation therapy after implant-based reconstruction, adverse chemotherapy effects, scar across the central breast mound, and smoking habit. The average time for tattooing was 29 min (range, 15–45 min). The average overall satisfaction score was 8.1 on a 10-point scale, which was significantly the highest compared with that of other techniques. Conclusion The tattoo-only nipple-areola complex reconstruction technique is an essential option to consider and utilize in selected patients who refuse another operation for nipple reconstruction for various reasons. Moreover, tattoo-only nipple-areola complex reconstruction has distinct advantages for patients with potential risk factors for poor outcome after conventional nipple-areola complex reconstruction.