Dermal Micropigmentation for the Nipple-areolar Complex Reconstruction: Integrative Literature Review
DOI:
https://doi.org/10.32635/2176-9745.RBC.2022v68n3.2143Keywords:
tattooing, nipples, breast neoplasms, women’s health, evidence based practiceAbstract
Introduction: Since 1986, dermal micropigmentation commonly known as tattooing has been a technique for reconstruction of the nipple-areola complex. Objective: To identify scientific evidence in the literature on the practice of dermal micropigmentation for reconstruction of the nipple-areola complex in women treated for breast cancer. Method: Integrative review upon search in the databases PubMed, SciELO and LILACS resulting in 14 articles selected according to the eligibility criteria. The review was reported according to PRISMA criteria, and the level of evidence classified according to the Oxford Center for Evidence-Based Medicine criteria. Results: 71.4% of the studies presented level four of evidence. The findings were synthesized in four categories: 1) dermal micropigmentation as the method of choice; 2) recommended period for micropigmentation; 3) steps of dermal micropigmentation; 4) expected and adverse reactions from micropigmentation. Conclusion: Dermal micropigmentation is a technique that has provided psychosocial benefits for women and offers the patient an areola with a natural appearance through a safe, fast, rarely painful procedure with low risk of complications, if biosafety measures are in place. Decisions in the process should be evidence-based and taken together with patients, respecting their wishes and sharing risks and benefits.
Downloads
References
Volkmer C, Santos EKA, Erdmann AL, et al. Reconstrução mamária sob a ótica de mulheres submetidas à mastectomia: uma metaetnografia. Texto Contexto Enferm. 2019;8:1-17. doi: https://doi.org/10.1590/1980-265X-TCE-2016-0442 DOI: https://doi.org/10.1590/1980-265x-tce-2016-0442
Inocenti A, Santos MA, Loyola EAC, et al. Repercussão dos efeitos da cirurgia reconstrutora na vida de mulheres com neoplasias da mama. Texto Contexto Enferm. 2016;25(2):e4520014. doi: https://doi.org/10.1590/0104-07072016004520014 DOI: https://doi.org/10.1590/0104-07072016004520014
Presidência da República (BR). Lei nº 13.770, de 19 de dezembro de 2018. Altera as Leis n º 9.656, de 3 de junho de 1998, e 9.797, de 6 de maio de 1999, para dispor sobre a cirurgia plástica reconstrutiva da mama em casos de mutilação decorrente de tratamento de câncer. Diário Oficial da União, Brasília, DF. 2018 dez 20 [acesso 2021 mar 6]; Seção 1:1. Disponível em: http://www.planalto.gov.br/ccivil_03/_ato2015-2018/2018/lei/L13770.htm
Satteson ES, Brown BJ, Nahabedian MY. Nipple-areolar complex reconstruction and patient satisfaction: a systematic review and meta-analysis. Gland Surg. 2017;6(1):4-13. doi: https://doi.org/10.21037/gs.2016.08.01 DOI: https://doi.org/10.21037/gs.2016.08.01
Sisti A. Nipple-areola complex reconstruction. Medicina (Kaunas). 2020;56(6):296. doi: https://doi.org/10.3390/medicina56060296 DOI: https://doi.org/10.3390/medicina56060296
Sisti A, Grimaldi L, Tassinari J, et al. Nipple-areola complex reconstruction techniques: a literature review. Eur J Surg Oncol. 2016;42(4):441-65. doi: https://doi.org/10.1016/j.ejso.2016.01.003 DOI: https://doi.org/10.1016/j.ejso.2016.01.003
Nimboriboonporn A, Chuthapisith S. Nipple-areola complex reconstruction. Gland Surg. 2014;3(1):35-42. doi: https://doi.org/10.3978/j.issn.2227-684X.2014.02.06
Mendes KDS, Silveira RCCP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm. 2008;17(4):758-64. doi: https://doi.org/10.1590/S0104-07072008000400018 DOI: https://doi.org/10.1590/S0104-07072008000400018
Souza MT, Silva MD, Carvalho R. Integrative review: What is it? How to do it? Einstein (São Paulo). 2010;8(1):102-6. doi: https://doi.org/10.1590/S1679-45082010RW1134 DOI: https://doi.org/10.1590/s1679-45082010rw1134
Shamseer L, Moher D, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;350:g7647. doi: https://doi.org/10.1136/bmj.g7647 DOI: https://doi.org/10.1136/bmj.g7647
OCEBM Levels of Evidence Working Group. The Oxford 2011 levels of evidence [Internet]. Oxford: Centre for Evidence-Based Medicine; 2011 [cited 2021 Mar 6]. Available from: https://www.cebm.net/wp-content/uploads/2014/06/CEBM-Levels-of-Evidence-2.1.pdf
Watson JD, Sainsbury JRC, Dixon JM. Breast reconstruction after surgery. BMJ [Internet]. 1995 [cited 2021 June 14];310:117-21. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2548509/pdf/bmj00575-0051.pdf DOI: https://doi.org/10.1136/bmj.310.6972.117
Bhatty MA, Berry RB. Nipple-areola reconstruction by tattooing and nipple sharing. Br J Plast Surg. 1997;50(5):331-4. doi: https://doi.org/10.1016/s0007-1226(97)90541-5 DOI: https://doi.org/10.1016/S0007-1226(97)90541-5
Brennan M. Breast reconstruction. Can Fam Physician [Internet]. 2000 [cited 2021 June 14];46:1981-2. Available from: https://www.cfp.ca/content/cfp/46/10/1981.full.pdf
Tostes ROG, Silva KDA, Andrade Júnior JCCG, et al. Reconstrução do mamilo por meio da técnica do retalho C-V: contribuição à técnica. Rev Bras Cir Plást [Internet]. 2005 [acesso 2021 jun 14];20(1):36-9. Disponível em: http://www.rbcp.org.br/details/152/pt-BR/reconstrucao-do-mamilo-por-meio-da-tecnica-do-retalho-c-v--contribuicao-a-tecnica
Teymouri HR, Stergioula S, Eder M, et al. Breast reconstruction with autologous tissue following mastectomy. Hippokratia [Internet]. 2006 [cited 2021 June 14];10(4):153-62. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464250/pdf/hippokratia-10-153.pdf
Costa MP, Ferreira MC. Aesthetic quality of the nipple-areola complex in breast reconstruction with a new local graft technique. Aesthetic Plast Surg. 2009;33(5):774-9. doi: https://doi.org/10.1007/s00266-009-9387-z DOI: https://doi.org/10.1007/s00266-009-9387-z
Goh SCJ, Martin NA, Pandya AN, et al. Patient satisfaction following nipple-areolar complex reconstruction and tattooing. J Plast Reconstr Aesthet Surg. 2011;64(3):360-3. doi: https://doi.org/10.1016/j.bjps.2010.05.010 DOI: https://doi.org/10.1016/j.bjps.2010.05.010
Pessoa SGP, Matos JRF, Dias IS, et al. Técnica simples e segura para a reconstrução areolopapilar com tatuagem intradérmica. Rev Bras Cir Plást. 2012;27(3):415-20. doi: https://doi.org/10.1590/S1983-51752012000300015 DOI: https://doi.org/10.1590/S1983-51752012000300015
Pérez-Guisado P, Rodríguez-Mérida C, Rioja LF. Areola size and jugulum nipple distance after bilateral mastectomy and breast reconstruction. Eplasty [Internet]. 2013 [cited 2021 June 14];13:e56. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819114/
Jalini L, Lund J, Kurup V. Nipple reconstruction using the C-V flap technique: long-term outcomes and patient satisfaction. World J Plast Surg [Internet]. 2017 [cited 2021 June 14];6(1):68-73. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5339612/
Weissler EH, Schnur JB, Lamelas AM, et al. The necessity of the nipple: redefining completeness in breast reconstruction. Ann Plast Surg. 2017;78(6):646-50. doi: https://doi.org/10.1097/SAP.0000000000000943 DOI: https://doi.org/10.1097/SAP.0000000000000943
Hong KY, Kim YE, Minn KW, et al. Immediate nipple reconstruction during implant-based breast reconstruction. Aesthetic Plast Surg. 2017;41(4):793-9. doi: https://doi.org/10.1007/s00266-017-0804-4 DOI: https://doi.org/10.1007/s00266-017-0804-4
Cha HG, Kwon JG, Kim EK. Simultaneous nipple-areola complex reconstruction technique: combination nipple sharing and tattooing. Aesthetic Plast Surg. 2019;43(1):76-82. doi: https://doi.org/10.1007/s00266-018-1247-2 DOI: https://doi.org/10.1007/s00266-018-1247-2
Laitano FF, Oliveira Neto FL. Tatuagem associada ao retalho em C-V para reconstrução do complexo areolopapilar em tempo único. Rev Bras Cir Plást. 2018;33(1):19-23. doi: https://doi.org/10.5935/2177-1235.2018RBCP0004 DOI: https://doi.org/10.5935/2177-1235.2018RBCP0004
van Verschuer VMT, Mureau MAM, Gopie JP, et al. patient satisfaction and nipple-areola sensitivity after bilateral prophylactic mastectomy and immediate implant breast reconstruction in a high breast cancer risk population: nipple-sparing mastectomy versus skin-sparing mastectomy. Ann Plast Surg. 2016;77(2):145-52. doi: https://doi.org/10.1097/sap.0000000000000366 DOI: https://doi.org/10.1097/SAP.0000000000000366
Cohen WA, Mundy LR, Ballard TNS, et al. The BREAST-Q in surgical research: a review of the literature 2009-2015. J Plast Reconstr Aesthet Surg. 2016;69(2):149-62. doi: https://doi.org/10.1016/j.bjps.2015.11.013 DOI: https://doi.org/10.1016/j.bjps.2015.11.013
Bezerra FJF, Moura RMG. Reconstrução da papila e imediata tatuagem do complexo areolopapilar: técnica, resultados e revisão de literatura. Rev Bras Cir Plást. 2018;33(1):12-8. doi: https://doi.org/10.5935/2177-1235.2018RBCP0003 DOI: https://doi.org/10.5935/2177-1235.2018RBCP0003
Cha HG, Kwon JG, Kim EK, et al. Tattoo-only nipple-areola complex reconstruction: another option for plastic surgeons. J Plast Reconstr Aesthet Surg. 2020;73(4):696-702. doi: https://doi.org/10.1016/j.bjps.2019.11.011 DOI: https://doi.org/10.1016/j.bjps.2019.11.011
Ramos RFM, Strassburger CP, Falcão M, et al. Reconstrução do complexo areolo-papilar: do que dispomos atualmente? Rev Bras Mastologia [Internet]. 2016 [2021 Jun 14];26(1):18-23. doi: http://www.mastology.org/wp-content/uploads/2016/03/MAS-v26n1_18-23.pdf DOI: https://doi.org/10.5327/Z201600010005RBM
Hammond JB, Teven CM, Bernard RW, et al. 3D nipple-areolar tattoo: it's technique, outcomes, and utilization. Aesthetic Plast Surg. 2021;5(2):453-458. doi: https://doi.org/10.1007/s00266-020-01967-w DOI: https://doi.org/10.1007/s00266-020-01967-w
Starnoni M, Baccarani A, Pinelli M, et al. Tattooing of the nipple-areola complex: What not to do. A case series. Ann Med Surg (Lond). 2020;55:305-7. doi: https://doi.org/10.1016/j.amsu.2020.05.041 DOI: https://doi.org/10.1016/j.amsu.2020.05.041
Lewin R, Amoroso M, Plate N, et al. The aesthetically ideal position of the nipple-areola complex on the breast. Aesthetic Plast Surg. 2016;40(5):724-32. doi: https://doi.org/10.1007/s00266-016-0684-z DOI: https://doi.org/10.1007/s00266-016-0684-z
Ministério da Saúde (BR), Agência Nacional de Vigilância Sanitária, Diretoria Colegiada. Resolução-RDC nº 64, de 23 de fevereiro de 2016. Altera a Resolução da Diretoria Colegiada RDC nº 55, de 6 de agosto de 2008, para mudar os requisitos de segurança e eficácia para o registro de produtos implantáveis, utilizados nos procedimentos de pigmentação artificial permanente da pele [Internet]. Diário Oficial da União, Brasília, DF. 2016 fev 24 [acesso 2021 jun 14]; Edição 36; Seção 1:30. Disponível em: https://www.in.gov.br/materia/-/asset_publisher/Kujrw0TZC2Mb/content/id/22420745/imprensanacional
Galsworthy V, Pilley M. Micropigmentation (medical tattooing) UHL guideline [Internet]. Leicester (UK): University Hospitals of Leicester NHS Trust; Nov 2012 [reviewed 2020 July; cited 2021 June 14]. Available from: https://secure.library.leicestershospitals.nhs.uk/PAGL/Shared%20Documents/Micropigmentation%20(Medical%20Tattooing)%20UHL%20Guideline.pdf
Kristoffersen CM, Seland H, Hansson E. A systematic review of risks and benefits with nipple-areola-reconstruction. J Plast Surg Hand Surg. 2017;51(5):287-95. doi: https://doi.org/10.1080/2000656X.2016.1251935 DOI: https://doi.org/10.1080/2000656X.2016.1251935
Bottega FH, Fontana RT. A dor como quinto sinal vital: utilização da escala de avaliação por enfermeiros de um hospital geral. Texto Contexto Enferm. 2010;19(2):283-90. doi: https://doi.org/10.1590/S0104-07072010000200009 DOI: https://doi.org/10.1590/S0104-07072010000200009
National Health Service, West Hertfordshire Hospitals. Nipple areola micro-pigmentation (tattooing): patient information [Internet]. Hertfordshire, (UK): Breast Care Unit; 2015 May [review 2018 May; cited 2021 June 14]. Available from: https://www.westhertshospitals.nhs.uk/patientinformation/documents/oncology/00122_4-17v02%20Nipple%20Areola%20Micro-Pigmentation%20Patient%20Information%20Leaflet%20FINAL.pdf
National Health Service, University Hospitals Coventry and Warwickshire. Breast care: tattooing service [Internet]. Version 8.1. Coventry (UK): UHCW; [update 2021 Feb; cited 2021 June 14]. Available from: https://www.uhcw.nhs.uk/download/clientfiles/files/Patient%20Information%20Leaflets/Surgical%20Services/Breast/Tattooing%20service.pdf
Serup J, Carlsen KH. Patch test study of 90 patients with tattoo reactions: negative outcome of allergy patch test to baseline batteries and culprit inks suggests allergen(s) are generated in the skin through haptenization. Contact Dermatitis. 2014;71(5):255-63. doi: https://doi.org/10.1111/cod.12271 DOI: https://doi.org/10.1111/cod.12271
Joseph WJ, Roy E, Stofman GM. Delayed hypersensitivity reaction after nipple tattooing: a novel case report. Plast Reconstr Surg Glob Open. 2019;7(9):e2394. doi: https://doi.org/10.1097/GOX.0000000000002394 DOI: https://doi.org/10.1097/GOX.0000000000002394
Published
How to Cite
Issue
Section
License
Os direitos morais e intelectuais dos artigos pertencem aos respectivos autores, que concedem à RBC o direito de publicação.
This work is licensed under a Creative Commons Attribution 4.0 International License.
