Invited Discussion on: A Survey on the Safety and Patient Satisfaction After Nipple-Areola Tattooing
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: A Survey on the Safety and Patient Satisfaction After Nipple-Areola Tattooing Peter D. Scott1
Received: 9 November 2020 / Accepted: 11 November 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. The authors of this article [1] are to be complimented on a thorough and comprehensive study of nipple-areola tattooing in Japanese patients. There have been a number of recent articles on nippleareola reconstruction post mastectomy. This article reports, in their Japanese patients, a high satisfaction rate and acceptance of the nipple-areola tattooing and a very low complication rate [1]. Gougoutas et al. [2] have reported on the nipple-areola reconstruction option and pros and cons of the various procedures available. Han Gyu Cha et al. [3] found that nipple sharing and tattooing was a very good safe option and well accepted by their Korean patients. Tomita et al. [4] went into great detail of the colour matches, fading and types of ink available that they used on their Japanese patients and also followed up colour changes in the tattoo with time. The areola tattooing techniques have improved significantly, and the current trend is to do 3D nipple-areola tattooing. Halvorson et al. [5] presented their technique and felt that by introducing ‘‘realism’’ in tattooing the aesthetics of this reconstruction improved. Azouz et al. [6] have taken this a step further by developing a stencil that will help the less skilled tattoo artist to produce a 3D image of the nipple-areola complex. Montgomery tubercles can & Peter D. Scott [email protected] 1
be highlighted, and a guide prevents placing the needle and the pigment too deep in the dermis. Hammond et al. [7] looked at long-term results of 3D tattooing alone and they found that advancing age was not a contra-indication to using this technique. They also found that the colour fading may lead to revision tattooing. Azadgoli et al. [8] found 90% of patients were happy with the results of their reconstruction but those that underwent nipple-areola complex reconstruction found that to be the least satisfactory part of their reconstruction. However, re-doing nippleareola tattooing is less invasive and gives high patient satisfaction. Ahmad and Lista [9] have done a very good commentary on this article. Finally, who does the tattooing? This may well depend on the regulations in your particular country. In Japan, medical professionals are required to do this. In other countries, there is a certain stigma of patients going to a tattoo parlour to have this performed. A good alternative would be for the tattoo artist to come into one’s offices to do these procedures. The ideal person is a trained med
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