Submit an Article > Register > Login >

Annali

dell'Istituto Superiore di Sanità

Search
Vol. 56 No. 4 (2020)
Original Articles
2020-12-28
Share on

Dermopigmentation of the nipple-areola complex in a dedicated breast cancer centre, following the Treviso Hospital (Italy) LILT model

Authors

Alessandro Gava , Antonia Pirrera , Alessandra De Dominicis , Rita Molinaro , Alessandra Lepri , Carmine Guarino , Christian Rizzetto , Giorgio Berna , Alberto Renzoni

Keywords: tattooing, nipple areola complex, restore, scar

Abstract

Background. Dermopigmentation, also known as medical tattooing, is a complementary technique in the reconstruction of the nipple-areola and an adjuvant procedure to improve colour mismatch.  In 2009, tattooing of the nipple-areola complex (NAC) was introduced by Treviso Hospital through a project conducted in cooperation with the local section of the Italian Anti-Cancer League (LILT).

Methods. From 2010 to 2016, 169 patients treated for breast cancer underwent dermopigmentation treatments. Patients were selected by the hospital plastic and breast surgeons. Dermopigmentation was performed at the LILT facility following a specific procedure to ensure safety. A sterile disposable surgical set was used.

Results. Of 169 patients treated in 309 treatment sessions, no serious complications were reported after tattooing, with only three cases seen of minor complications. Patients expressed a high level of satisfaction (90%) with the aesthetic results.

Conclusion. The study found that dermopigmentation of the NAC is a safe approach, providing  benefits both to the patients and the hospital itself. Medical tattooing of the NAC is a simple and safe nonsurgical technique that reduces missed workdays and increases the time available for other commitments. This ultimately translates into savings for society and the healthcare system.

References

  1. I numeri del cancro in Italia 2018. Associazione Italiana di Oncologia Medica (AIOM), Associazione Italiana Registro Tumori (AIRTUM), Fondazione AIOM e Progressi delle Aziende Sanitarie per la Salute in Italia (PASSI)
  2. Fanceschini G, Martin Sanchez A, Di Leone A, Magno S, Moschella F, Accetta C, Masetti R. New trends in breast cancer surgery: a therapeutic approach increasingly efficacy and respectful of the patient. G Chir. 2015 Jul-Aug;36(4):145-52
  3. Few JW, Marcus JR, Casas LA, et al. Long-term predictable nipple projection following reconstruction. Plast Reconstr Surg 1999; 104:1321-4
  4. Evans KK, Rasko Y, Lenert J, et al. The use of calcium hydroxylapatite for nipple projection after failed nippleareolar reconstruction: early results. Ann Plast Surg 2005; 55:25-9
  5. Berson MI. Construction of pseudoareola. Surgery 1946; 20:808.
  6. Adams WM. Labial transplant for correction of loss of the nipple. Plast Reconstr Surg (1946) 1949; 4:295-8
  7. Millard DR Jr. Nipple and areola reconstruction by splitskin graft from the normal side. Plast Reconstr Surg 1972; 50:350-3
  8. Brent B, Bostwick J. Nipple-areola reconstruction with auricular tissues. Plast Reconstr Surg 1977; 60:353-61
  10. Klatsky SA, Manson PN. Toe pulp free grafts in nipple reconstruction. Plast Reconstr Surg 1981; 68:245-8
  11. Boulart L, Mimoun M, Noel W, Malca N, Chaouat M, Boccara D. Dealing with tattoos in plastic surgery. Complications and medical use. Ann Chir Plast Esthet. 2017 Apr;62(2):e23-e29. doi: 10.1016/j.anplas.2016.09.004. Epub 2016 Oct 12
  12. Drost BH, van de Langenberg R, Manusama OR, Janssens AS, Sikorska K, Zuur CL, Klop WM, Lohuis PJ. Dermatography (Medical Tattooing) for scars and skin grafts in head and neck patients to improve appearance and quality of Life. JAMA Facial Plast Surg. 2017 Jan 1;19(1):16-22. doi: 10.1001/jamafacial.2016.1084
  13. Buchman HH, Larson DL, Huang TT, Lewis SR. Nipple and areola reconstruction in the burned breast. The “double bubble” technique. Plast Reconstr Surg 1974; 54:531-6
  14. Rees TD. Reconstruction of the breast areola by intradermal tattooing and transfer. Case report. Plast Reconstr Surg 1975; 55:620-1
  15. Spear SL, Convit R, Little JW 3rd. Intradermal tattoo as an adjunct to nipple-areola reconstruction. Plast Reconstr Surg 1989; 83:907-11
  16. Halvorson E G, Cormican M, West M E, Myers V. Three-Dimensional Nipple-Areola Tattooing: A New Technique with Superior Results. Plast. Reconstr. Surg 2014; 133:1073-5
  17. Uhlmann NR, Martins MM, Piato S.3D areola dermopigmentation (nipple‐areola complex). Breast J. 2019; 25:1214–1221. https ://doi.org/10.1111/tbj.13427
  18. Bodin F, Bruant-Rodier C, Ruffenach L, Dissaux C. The reconstruction of the nipple-areolar. Ann Chir Plast Esthet. 2018 Nov; 63(5-6):559-568 doi: 10.1016/j.anplas.2018.06.010. Epub 2018 Jul 7
  19. Sisti A, Grimaldi L, Tassinari J, Cuomo R, Fortezza L, Bocchiotti M A, Roviello F, D’Aniello C, Nisi G. Nipple-areola complex reconstruction techniques: A literature review. EJSO 42 (2016) 441e465 http://dx.doi.org/10.1016/j.ejso.2016.01.003
  20. Goh SCJ, Martin NA, Pandya AN, Cutress RI. Patient satisfaction following nipple-areolar complex reconstruction and tattooing. J Plast Reconstr Aesthet Surg. 2011 Mar;64(3):360-3. doi: 10.1016/j.bjps.2010.05.010. Epub 2010 Jun 8
  21. K El-Ali, M Dalal, CC Kat. Tattooing of the nipple-areola complex: review of outcome in 40 patients. J Plast Reconstr Aesthet Surg. 2006;59(10):1052-7. Epub 2006 Jun 12
  22. Franceschini G, Di Leone A, Masetti R. The Breast Unit Update on advantages and the open issues. Ann Ital Chir. 2014 Sep-Oct;85(5):407-12
  23. Ross JR, Matava MJ. Tattoo-induced skin "burn" during magnetic resonance imaging in a professional football player: a case report. Sports Health. 2011 Sep;3(5):431-4
  24. Callaghan MF, Negus C, Leff AP, Creasey M, Burns S, Glensman J, Bradbury D, Williams E, Weiskopf N. Safety of Tattoos in Persons Undergoing MRI. N Engl J Med. 2019 Jan 31;380(5):495-496. doi: 10.1056/NEJMc1811197
  25. White CP, Gdalevitch P, Strazar R, Murrill W, Guay NA. Surgical tips: Areolar tattoo prior to nipple reconstruction. J Plast Reconstr Aesthet Surg. 2011 Dec;64(12):1724-6 doi:10.1016/j.bjps.2011.06.031. Epub 2011 Jul 21
  26. Børsen-Koch M, Bille C & Thomsen J B. Promising results after single-stage reconstruction of the nipple and areola complex. Danish Medical Journal 2013;60(10): A4674
  27. Koumanis DJ, ColqueA, EisemannML,Smith J.Breast Surgery under local anesthesia: second-stage implant Exchange, nipple flap reconstruction, and breast augmentation. Clin Plast Surg 2013; 40:583-91
  28. Bykowski MR, Emelife PI, Emelife NN, Chen W, Panetta NJ, de la Cruz C. Nipple-areola complex reconstruction improves psychosocial and sexual well-being in women treated for breast cancer. J Plast Reconstr Aesthet Surg. 2017 Feb;70(2):209-214. doi: 10.1016/j.bjps.2016.10.009. Epub 2016 Nov 9
  29. Kesson EM, Allardice GM, George WD, Burns HJG, Morrison DS. Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. Br Med J 2012; 344:1-9
  30. Italia. Decreto del presidente del consiglio dei ministri 12 gennaio 2017. Definizione e aggiornamento dei livelli essenziali di assistenza, di cui all'articolo 1, comma 7, del decreto legislativo 30 dicembre 1992, n. 502. Gazzetta Ufficiale ¬– Serie Generale n. 65, 18 marzo 2017
  31. Fabbrocini G, Cameli N, Romano MC, Mariano M, Panariello L, Bianca D, Monfrecola G. Chemotherapy and skin reactions. J Exp Clin Cancer Res. 2012 May 28; 31:50. doi: 10.1186/1756-9966-31-50
  32. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995 Mar 30;31(5):1341-6
  33. Wu Y, Aravind S, Ranganathan G, Martin A, Nalysnyk L. Anemia and thrombocytopenia in patients undergoing chemotherapy for solid tumors: a descriptive study of a large outpatient oncology practice database, 2000-2007. Clin Ther. 2009;31 Pt 2:2416-32. doi: 10.1016/j.clinthera.2009.11.020
  34. Miarons M, Velasco M, Campins L, Fernández S, Gurrera T, Lopez-Viaplana L. Gradual thrombocytopenia induced by long-term trastuzumab exposure. J Clin Pharm Ther. 2016 Oct;41(5):563-5. doi: 10.1111/jcpt.12416. Epub 2016 Jul 18
  35. Islam PS, Chang C, Selmi C, Generali E, Huntley A, Teuber SS, Gershwin ME. Medical Complications of Tattoos: A Comprehensive Review. Clin Rev Allergy Immunol. 2016 Apr; 50(2):273-86. doi: 10.1007/s12016-016-8532-0
  36. Bassi A, Campolmi P, Cannarozzo G, Conti R, Bruscino N, Gola M, Ermini S, Massi D, Moretti S. Tattoo-ssociated skin reaction: the importance of an early diagnosis and proper treatment. Biomed Res Int. 2014;2014:354608. doi: 10.1155/2014/354608. Epub 2014 Jul 23
  37. www.salisbury.nhs.uk consulted dec.2019
  38. Smallman A, Crittenden T, Yip J M, Dean NR. Does nipple-areolar tattooing matter in breast reconstruction? A cohort study using the BREAST-Q. JPRAS 2018 Feb 27;16:61 doi: 10.1016/j.jpra.2018.01.003. eCollection 2018 Jun
  39. Heo JW, Park SO, Jin US. A Nipple-Areolar Complex Reconstruction in Implant-Based Breast Reconstruction Using a Local Flap and Full-Thickness Skin Graft. Aesthetic Plast Surg. 2018;42(6):1478–1484. doi:10.1007/s00266-018-1162-6
  40. Italia. Circolare del Ministero della Salute prot. n. 14138 del 15/05/2019. Nota circolare sui tatuaggi con finalità medica; chiarimenti in merito alla pigmentazione dell’areola capezzolo.

Downloads

PDF
Authors

Alessandro Gava - Radiotherapy Department Treviso Hospital - Azienda ULSS 2 Marca Trevigiana, Italy

Antonia Pirrera - Istituto Superiore di Sanità https://orcid.org/0000-0002-0215-4842

Alessandra De Dominicis

Rita Molinaro - Expert consultant in medical tattooing for LILT (Lega Italiana per la Lotta contro i Tumori), Treviso, Italy

Alessandra Lepri - National Centre for Control and evaluation of medicines, Istituto Superiore di Sanità, Rome, Italy

Carmine Guarino - USMAF-SASN Ministry of Health, Rome, Italy

Christian Rizzetto - Breast Surgery Department Treviso Hospital - Azienda ULSS 2 Marca Trevigiana, Italy

Giorgio Berna - Plastic Surgery Department Treviso Hospital- Azienda ULSS 2 Marca Trevigiana, Italy

Alberto Renzoni - National Centre for Innovative Technologies in Public Health, Istituto Superiore di Sanità, Rome, Italy

License

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Copyright

Copyright (c) 2020 Annali dell'Istituto Superiore di Sanità

How to Cite
Gava, A., Pirrera, A., De Dominicis, A., Molinaro, R., Lepri, A., Guarino, C., Rizzetto, C., Berna, G., & Renzoni, A. (2020). Dermopigmentation of the nipple-areola complex in a dedicated breast cancer centre, following the Treviso Hospital (Italy) LILT model. Annali dell’Istituto Superiore Di Sanità, 56(4), 444–451. Retrieved from https://annali.iss.it/index.php/anna/article/view/1147
  • Abstract viewed - 490 times
  • PDF downloaded - 195 times