Increasing Popularity of Tattoo-Only Nipple-Areolar Complex Reconstruction

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.