Background: Nipple-areolar complex (NAC) reconstruction can be broadly categorized into surgical reconstruction, tattooing, or both. NAC tattooing has shown continued advances recently, resulting in increased discussion of tattoo-only methods within the literature.
Objective: This study aims to quantify recent trends in choice of NAC reconstruction and explore driving factors.
Methods: Patients who underwent postmastectomy breast and NAC reconstruction between January 2007 and December 2021 at a single academic institution were reviewed and grouped based on method of NAC reconstruction: (1) surgical-only, (2) tattoo-only, and (3) both surgical and tattoo. Trends were assessed in each group using Poisson regression.
Results: The study included 138 patients; 17.4% (n = 24) were in the surgical-only group, 16.7% (n = 23) tattoo-only, and 65.9% (n = 91) both surgical and tattoo. Over the 15-year period, patients receiving tattoo-only NAC reconstruction significantly increased (β = 0.173, P < 0.0001), while those receiving both surgical and tattoo significantly decreased (β = -0.064, P = 0.007). There were no significant changes in surgical-only (β = 0.013, P = 0.563) or total (any type) NAC reconstruction (β = -0.013, P = 0.503). Rates of breast reconstruction significantly increased (β = 0.062, P < 0.0001). Variables such as autologous versus implant-based, unilateral versus bilateral, revision number, and radiation were stable over time and were not significantly associated with NAC reconstruction method.
Conclusions: There is a significant trend toward tattoo-only and away from surgical-only reconstruction over the past 15 years, highlighting the importance of access to tattoo-based NAC reconstruction as part of comprehensive breast reconstruction care. The less invasive nature of tattooing and increase in tattoo quality are possible reasons for the increase in popularity.
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