Tattoo artists play new role in breast reconstruction

Three-dimensional nipple-areola tattoos provide superior aesthetic outcomes, reports PRS

May 1, 2014
American Society of Plastic Surgeons (ASPS)

For women undergoing breast reconstruction, professional tattoo artists can achieve "aesthetically superior" results by creating realistic three-dimensional tattoos of the nipple and surrounding areola, according to a report in the May issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

ASPS Member Surgeon Dr. Eric G. Halvorson of Brigham & Women's Hospital, Boston, and colleagues report their experience with three-dimensional tattoos of the nipple-areola complex (NAC) created by professional tattoo artists to complete breast reconstruction after mastectomy.

They write, "The application of '3D' techniques or 'realism' in tattoo artistry has significant potential to improve the aesthetic outcomes of reconstructive surgery."

3D tattoos provide alternative to nipple reconstruction

Nipple-areola complex tattoos have long been used as part of breast reconstruction in some situations. For example, in women who have undergone radiation therapy or those who don't want another surgical procedure to reconstruct the nipple.

Traditionally, plastic surgeons have performed NAC tattoos themselves using very basic techniques: lighter ink for the areola surrounding a circle of darker ink for the nipple.

But in recent years, Dr. Halvorson and coauthors have recognized that professional tattoo artists can achieve superior results.

Tattoo artists such as Vinnie Myers of Fredericksburg, Md. - one of the authors of the new paper - have developed techniques of creating realistic-looking three-dimensional tattoos. In contrast to the traditional two-dimensional techniques used by plastic surgeons, these artists use color to create a more lifelike appearance, including "shadow effects" to create the illusion of a projecting nipple.

Professional tattoo artists also use more sophisticated techniques in terms of machine speed, needle type and color mixing. Through their technical skills and artistry, these artists can create NAC tattoos that compensate for asymmetries of the reconstructed breast mound. They can also create a more realistic-looking areola, down to the tiny Montgomery glands surrounding the nipple.

Because of the outstanding results achieved by professional artists, Dr. Halvorson and colleagues no longer perform NAC tattoos themselves.

"While referring patients to tattoo artists for 3D NAC reconstruction may take some business away from a surgeon's practice, it is our obligation to offer patients the best results possible," they write.

The costs of NAC tattooing may be partly reimbursed by insurance. For women who would feel uncomfortable going to a tattoo parlor, some tattoo artists now come in to work at medical facilities. The authors offer tips for finding a local artist who can create NAC tattoos; a listing may be found online at Pink Ink Project.

"The technique of 3D NAC tattoo presented is, in our opinion, a significant advance in obtaining improved aesthetic results for women undergoing breast reconstruction," Dr. Halvorson and colleagues write.

They believe that 3D tattoos may have the potential to enhance the aesthetic results of reconstruction in other areas of the body as well. For example, eyebrow or lip tattooing after facial reconstruction or fingernail tattoos in patients with reconstruction of the hand.

The researchers add, "Any prominence such as the nose, ear or nipple will achieve three-dimensionality when light and shadow are employed appropriately in two dimensions."