Dealing with tattoos in plastic surgery. Complications and medical use

Degree of satisfaction of women treated with reconstruction and dermopigmentation of the nipple-areola complex after breast reconstruction

OBJECTIVE

To evaluate the degree of satisfaction of women treated with dermopigmentation and reconstruction of the Areola-Nipple Complex (ANC) after breast reconstruction, as well as their demographic profile and clinical-evolutionary characteristics.

METHODS

Descriptive observational study including 128 women treated with dermopigmentation after oncologic breast reconstruction during 2018. In 2021 they were administered an adapted satisfaction questionnaire, which contains 27 items and categorizes satisfaction from 1-5, in addition other clinical-evolutionary and demographic variables were collected.

RESULTS

Mean age was 51 (±9) years, 89.1% had previously undergone PDA reconstruction. Mean satisfaction with dermopigmentation was 4.4 (±0.88) and 3.79 (±1.06) for PDA reconstruction. Complications were rare, but 54.5% (n = 54) of the patients reported that the CAP reconstruction did not offer the expected projection, 91.6% (n = 98) that the color had faded and 51.4% (n = 55) would choose permanent tattooing. It was perceived that, the higher the satisfaction of the CAP, the higher the satisfaction of dermopigmentation, while the older the age and previous chemotherapy treatment the lower the color durability (p value ≤ 0.05).

CONCLUSIONS

Patients who underwent reconstructive breast surgery show a high degree of satisfaction with dermopigmentation and surgical reconstruction of the PDA, but reiterate the low projecticity of the dermopigmentation and the surgical reconstruction of the PDA, but reiterate the low degree of satisfaction with the dermopigmentation.

[Secondary surgical and medical treatment of scars]

The authors, through their experience, take stock of current secondary management of scars whether they are pathological (hypertrophic, cheloid) or dystrophic (enlarged, hypo- or hyper-pigmented, adherent) by presenting surgical or medical solutions.

3D areola dermopigmentation (nipple-areola complex)

Surgical techniques for reconstructing the nipple-areola complex (NAC) pose disadvantages such as areola necrosis, loss of nipple projection, depression or local necrosis, temporary leave from professional activities due to convalescence, and operational costs, all of which are factors that may discourage patients from undergoing them. In this context, dermopigmentation stands out as an emerging nonsurgical option. It is an inexpensive outpatient procedure that mimics the nipple-areola complex by means of defining the areolar contour, Montgomery's tubercles, and a variety of colors that allow for individualization and contralateral symmetry. In this pioneering study, we propose to validate the 3D dermopigmentation technique as a preferential technique in the NAC reconstruction process. We selected 30 women with previous breast cancer who underwent conservative breast surgeries or mastectomy with NAC removal more than 6 months prior to their participating in our study. We employed the dermopigmentation technique, which we evaluated with the aid of questionnaires intended for patients, doctors, and tattooists. Among specialists, results were considered good and excellent with regard to overall esthetics (76.07%) and color (72.5%); whereas among patients, results were considered good and excellent with regard to overall satisfaction (95%) and color (100%); no adverse events were observed. Three-dimensional dermopigmentation proved to be a promising nonsurgical technique for nipple-areola complex reconstruction.

A Practical Guide About Tattooing in Patients with Chronic Skin Disorders and Other Medical Conditions

With tattoos becoming increasingly mainstream, dermatologists are more and more often consulted by patients who are considering getting an ornamental, cosmetic, or even a medical tattoo, and who subsequently ask for advice. This includes not only patients with chronic skin diseases such as psoriasis or atopic dermatitis but also patients with other medical conditions. This review first explores the reasons why patients may want to get a tattoo and aims to offer some key information to dermatologists on what they should know about tattooing and the main risks associated with this procedure. Second, the risks and recommendations of tattooing in patients with specific skin diseases are described more in detail, and the relative and strict contraindications discussed, including the necessity to discontinue certain treatments that could influence the outcome of the procedure and the final result. Our aim was to provide dermatologists with the current knowledge they need to help their patients make adequate and informed choices on skin art, focusing specifically on considerations in patients with chronic skin conditions. Finally, other aspects regarding some general systemic conditions and concomitant diseases that the patient could present are also addressed. In particular, the risks of tattooing in patients with diabetes, coagulation disorders, heart conditions, immunosuppressive treatments, and pregnancy are discussed.