Table 2.
Main characteristics and results of full-texts included in the review
| Author; year; Country | Study design | Population | Methods | Adverse events | Main results | ||||
|---|---|---|---|---|---|---|---|---|---|
| Professionals and training | Time | Materials | Data collection tools/analysis | Endpoints | |||||
| Sowa et al. (2021) Japan | retrospective study | 3D-E technique tattoo (N = 61) VS conventional technique tattoo (N = 49) after flap-based nipple reconstruction | One plastic surgeon with little training | 21 months | Tattoo machine | 10-points scale | Four senior plastic surgeons evaluated from pictures (1) 3D appearance (2) symmetry of NAC | NR | Higher appearance and symmetry in 3D-E tattoos. |
| Goh et al. (2011) UK | retrospective study | NAC tattoo (N patients = 172) | specialist nurse tattooist | 8 years | Tattoo machine | 5-points scale postal questionnaire | Patient satisfaction with the NAC | local erythema (n = 8); bleeding (n = 8); local infection (N = 4) | 110 respondents; 70% were satisfied. |
| Starnoni et al. (2020) ITALY | restrospective study | NAC tattoo after nipple reconstruction (N patients = 48) | surgical trainees with 20 h- training with a professional tattoo artist | 2 years | NR | Questionnaire | Patients’ satisfaction | scar nipple dehiscence (N = 3) | 92% were satisfied or very satisfied. |
| DiCenso and Ficher-Cartlidge (2015) USA | cross-sectional study | BC RNs (n = 43) VS BC non-RNs (n = 25) | NA | 5 weeks | NA | Online survey | likelihood of discussing options for NAC tattooing and recommending tattoo artists | NA | RNs were significantly less likely to recommend a professional tattoo artist than non-RNs |
| Cha et al. (2019) KOREA | retrospective study | Tattoo-only NAC reconstruction (n = 20) (subgroup of 95 patients that reconstructed the NAC with other techniques) |
One surgeon Training: NR |
9 months | Tattoo machine | 10-points questionnaire | overall satisfaction | NR | Average overall satisfaction score: 8.1/10. significantly the highest compared with that of other techniques. |
|
Aslam et al. (2015) UK |
descriptive study | NAC tattoo after flap reconstruction (N patients = 292) | BC clinical nurse specialist trained in tattooing | 9 years | NR | Questionnaire | (1) Patient satisfaction (2) Relationship between RT and tattoo fading | NA |
Response rate: 60% 165/173 were happy with overall appearance 70% of RT patients reported fading. |
|
Gava et al. (2020) ITALY |
Pilot experimental study | BR (N patients = 169) | Advanced practice professionals | 6 years | Dermograph | Phone interview | (1) Patient satisfaction (2) Service usefulness | minor complications (N = 3) (topical allergic reaction, abrasion, and soreness) | high satisfaction of the aesthetic results (90%); the service was useful/very useful (97%). |
|
Smallman et al. (2018) AUSTRALIA |
cohort study | Nurse-performed NAC tattoo (N patients = 169) VS plastic surgeon-performed tattoo (N patients = 111) after BR |
Nurse/plastic surgeon Training: NR |
6 years | Tattoo machine | BREAST-Q questionnaire | Before/after patient satisfaction | NR |
Response rate: 48% Higher satisfaction with NAC after tattoo. No significant difference between clinicians. |
|
Uhlmann, Martins and Piato (2019) BRAZIL |
pilot experimental study | BR (N patients = 30) | Tattoo artist | 22 months | Tattoo machine | 5-point-scale | Patient and professionals’ satisfaction | No | Professionals: good and excellent overall esthetics (76%) and color (72%); tattooed patients (N = 20): overall satisfaction (95%) and color (100%). |
|
Murphy et al. (2010) IRELAND |
descriptive study | NAC tattooing after BR (N patients = 26) | clinical nurse specialist | 2 years | Tattoo machine | (1) Phone survey (2) computer program |
(1) Patient satisfaction (2) Color matching |
No | Median satisfaction score: 4.6/5; mean color match of 91%. |
|
Weissler et al. (2021) USA |
retrospective study | NAC tattooing after BR (N patients = 539) | physician assistant or plastic surgery trained by a nurse | 11 years | Tattoo machine | univariate analysis and multivariable regression model | identify risk factors for tattoo-related breast infections | tattoo-related infections ‘rate: 2.2% |
85.7% of infections occurred in IBR patients RT and prepectoral IBR are independent predictors of tattoo-related breast infection. |
NAC Nipplle Areola Complex; BMI Body Mass Index; IBR Implant Based Reconstruction; IV Intra-Venous; RT RadioTherapy; NR Not Reported; NA Not Applicable; BR Breast Reconstruction; BC Breast Cancer; RN Registered Nurse