Abstract
Background
Micropigmentation is a well-recognised option for nipple-areola complex reconstruction, as part of the breast reconstruction pathway for patients following mastectomy. As a part of delayed breast reconstruction, this treatment was put on hold during the COVID-19 pandemic.
Aims
To assess the views of patients regarding micropigmentation in response to the COVID-19 pandemic, and whether their attitudes to seeking out this part of the reconstructive journey had been altered.
Methods
A questionnaire undertaken with 53 patients between August & September 2020 attending the Micropigmentation clinic.
Findings
81.1% of patients reported COVID-19 had not impacted their decision, with a similar proportion happy to proceed with the treatment at the time of questioning.
Conclusions
The results highlight the importance of nipple-areola complex to our patients’ reconstructive journey.
Keywords: Nipple-Areola complex, NAC, Reconstruction, Patient perspectives, COVID-19, Pandemic
Dear Sir,
Introduction
Micropigmentation, also referred to as dermopigmentation and medical tattooing, is a well-recognised option for nipple-areola complex (NAC) reconstruction, either by itself, or in combination with surgical nipple reconstruction. Its importance to patients in the breast reconstruction journey has also been explored, and deemed a valuable part to the patient.1 The importance to patients of breast reconstruction following mastectomy has also been studied extensively and found that it can improve the patient's psychological wellbeing.2
The Covid-19 pandemic had a significant impact on health seeking behaviour, with significant reductions, particularly after the first lockdown period in the United Kingdom, and a very slow return to “pre-pandemic” levels.3 The British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) and the Association of Breast Surgery (ABS) issued statements regarding the recommencement of both immediate & delayed breast reconstruction, but these did not include or refer to NAC reconstruction.4
Our aim was to assess the views of patients regarding micropigmentation in response to the COVID-19 pandemic, and whether their attitudes to seeking out this part of the reconstructive journey had been altered.
Results
A review of 53 patients between August and December 2020 who were due to attend for NAC micropigmentation were surveyed for their opinions and views on micropigmentation during the COVID-19 pandemic. The majority of patients (56.6%) were awaiting their first micropigmentation intervention, with the remainder at varying later stages. Our micropigmentation team describes “Stage 0” patients as those awaiting their first intervention, with “Stage 1” being those awaiting their second intervention to re-apply the micropigmentation to build colours up. “Stage 2” and beyond follow the same pattern. “Top-up” refers to those patients receiving re-applications when the colours fade, which is normal with the semi-permanent pigments that are routinely used.
81.1% of surveyed patients reported that COVID-19 had not impacted on their decision to have micropigmentation, with the same proportion happy to proceed with micropigmentation at the time of questioning. 84.9% were not self-isolating in response to the pandemic, with the same proportion reporting they were well at the time of questioning. 94.3% of patients surveyed felt that micropigmentation was an important part of their reconstructive journey, with some describing it as “the end” of the journey, and others as the “most important” part of the journey.
Discussion
The breast reconstruction journey is incredibly variable and individualised to each patient. The psychological, social, and emotional impact of breast cancer and reconstruction is well established. The use of micropigmentation can provide a positive impact, allowing closure, and “an end” to the cancer journey of these patients. Whilst not every patient may wish for, or seek out, NAC micropigmentation, those who do describe benefits from it.
COVID-19 resulted in alteration of the provision of Breast Cancer care, which included the suspension of immediate breast reconstruction, which therefore impacted psychological health in those who experienced delays or alterations.5 In addition, COVID-19 also had an impact on health seeking behaviour in general. The data published by the Department of Health and Social Care (DHSC) and the Office of National Statistics (ONS) describes this in relation to primary care consultation rates. It is unlikely that this data set reflects or includes the specific patient group we have studied.
The micropigmentation clinics our team provided were halted during the first lockdown, as they were identified as “non-essential” during that time. When the service was recommenced, the clinic was relocated to a private hospital site during the pandemic. Many patients mentioned this as part of their positive experience, explaining that being away from an acute site, and so away from any COVID-19 patients, was reassuring, as well as the welcoming entrance to the clinic building, with clear directions within the building to the clinic room.
Formal review of consultation rates, including how these were conducted, for breast reconstruction and NAC reconstruction or micropigmentation on a national level would be of benefit. Nevertheless, the majority of women surveyed still felt that they wanted to proceed with micropigmentation and would have been happy to proceed at that time of the COVID-19 pandemic.
| Stages of micropigmentation | ||
|---|---|---|
| Stage 0 | 30 | 56.6% |
| Stage 1 | 11 | 20.8% |
| Stage 2 | 7 | 13.2% |
| Stage 3 | 2 | 3.8% |
| Stage 4 | 1 | 1.9% |
| “Top-up” | 2 | 3.8% |
| Total = | 53 | |
| Has COVID impacted your decision to have micropigmentation? | ||
|---|---|---|
| Y | 7 | 13.2% |
| N | 43 | 81.1% |
| Not documented | 3 | 5.7% |
| Are you happy to have micropigmentation done now? | ||
|---|---|---|
| Y | 43 | 81.1% |
| N | 4 | 7.5% |
| Not documented | 4 | 7.5% |
| Other | 2 | 3.8% |
Conclusion
Our review suggests the majority (81.1%) of women had not altered their decision on micropigmentation and would still proceed with it, despite the pandemic situation. This highlights the importance of body image from the patients’ own perceptions. While our study is limited by the small population size, it does reinforce the importance of micropigmentation in the breast reconstruction journey. More detailed reviews, such as formal Health Related Quality of Life outcomes of NAC micropigmentation, with or without Nipple or Breast reconstruction should be considered, in order to provide optimal information to our patients, but the individuality of this pathway must be appreciated when planning with our patients.
Ethical approval
Not required.
Declaration of Competing Interest
No conflicts of interested declared.
Funding
No funding required for this study.
Footnotes
Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.bjps.2022.06.032.
Appendix. Supplementary materials
References
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Associated Data
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