Nipple-Areola Micro-pigmentation (Tattooing)

This information sheet is designed to help you understand what is involved in the outpatient procedure of nipple-areola micro-pigmentation. The benefits and limitations of the procedure are outlined, and the necessary aftercare.

What is Micro-pigmentation?

It is the implantation of small amounts of natural pigment (dye) via a needle into the surface layer of the skin to create permanent colour.

It does not penetrate the skin as deeply as tattooing and the pigments and techniques are specially designed for the part of the body being treated.

It can be used to give colour to the nipple and areola following nipple reconstruction. Even if a nipple reconstruction has not been performed, the areola colour can still be implanted into breast skin and special shading techniques are used to create the appearance of a nipple.

Consequences and risks of the procedure

The procedure will be carried out by a nurse who has been specially trained and has gained experience in micro-pigmentation technique.

The procedure does carry some risks. The main risks are:

• Not achieving an exact colour match with the existing areola and/or nipple
• Scarring
• Spreading of the dye outside the areola area
• Uneven pigment colour
• Fading of colour over time you may not be entitled to top up treatment on the NHS. Your Nurse/consultant will have to apply for funding for this.  
• Allergy to the dye (rare)
• Skin infection

You will be involved in the decision of the colour match of your nipple/areola with the nurse before the procedure begins.

Is there an alternative?

The alternative is that you can choose not to have micropigmentation.

How many treatments are required to achieve the final result?

Most patients require a minimum of two initial treatments with at least one month between the first and second treatment.

A degree of colour fading is quite common and further follow-up treatments may be required to maintain the chosen colour. Follow up treatments may not be funded by the NHS, this will have to be applied for by your Nurse Specialist/Consultant

What factors may affect the results?

The outcome is partly determined by variations in skin type and can be affected by:-

• Medication
• Natural skin tones
• Skin characteristics (dryness, oiliness, sun damage, thickness, colour)
• The level of acidity of the skin
• Alcohol intake
• Smoking
• Individual healing ability
• Illness

Known allergies

It is very unlikely that you would develop an allergic reaction to the pigments used in micro-pigmentation. However, if you have any known allergies, the nurse may advise you to undergo a skin allergy test at least 24 hours before carrying out the procedure. This would involve applying a small patch of the pigments to be used and the local anaesthetic ointment that may be applied to an area of your skin. 

You would be asked to return after 24 hours to check for any evidence of an allergic reaction. If there is any reaction, it may not be safe to undergo the micro-pigmentation. 

Equipment Safety and Hygiene

The machine used for this procedure is cleaned between each patient use. Any part that comes into contact with the patient is sterilised before use and the needles are single use and disposed of after the procedure.

How long does the procedure take?

Your appointment can take anything from 20mins to one hour.  If local anaesthetic cream is to be used, this will need to be applied to the area at least half an hour before the procedure.

The nurse will complete a short assessment form about your general health before carrying out the procedure and ask you to sign a consent form. 

The area to be coloured will be marked by the nurse with a pen and the position checked with you, using a mirror.

The length of time it takes to actually complete the micro-pigmentation procedure varies with each individual according to:

• The position, width and depth of the nipple-areola area
• The depth of colour to be matched (follow-up treatments are shorter than the initial procedure)
• Acceptance of the pigment according to your skin type.

The pigment is applied using a pen-like device that works like a miniature sewing machine. The needle moves up and down very quickly, penetrating the outer layers of the skin and implanting the coloured pigment. The operator holds the machine while guiding it along the skin. The speed and power can be adjusted according to the individual. The pigments are built up using dots, lines or a circular motion.

What should you expect after the procedure?

You will experience slight swelling and redness following the procedure and the skin may feel “tight.” These symptoms should subside within one to seven days depending on how sensitive your skin is.

You should be able to resume normal activities immediately following the procedure. However, use of cosmetic skin products, excessive perspiration and exposure of the affected area to the sun should be avoided until the area is fully healed.

In the first few days after the procedure, the pigmented area of skin will form a scab. This will last for 14-21 days, after which the scab will gradually break off as healing takes place. You will then notice slight fading of the pigment and softening of the colour.

It is important that the healing process takes its natural course. Scarring can occur if the scabs are accidentally or deliberately removed.

Skin Care Instructions (to be followed after the procedure) 

The following instructions must be carefully followed for at least two weeks after the procedure to ensure a successful result:

• The dressing, which is applied immediately after the procedure, should remain in place for at least two days and should not be allowed to get wet.
• After two days, you can take a bath or shower.  If the dressing does not get wet and is secure, it should remain in place.  The dressing should only be removed if it becomes wet or is loose and easily removed.  Do not touch or use soap on the affected area.
• If the dressing is removed, a clean dressing should be applied immediately after each bath/shower for protection. You will be supplied with spare dressings.  

Once the area has healed, yellow or white soft paraffin (Vaseline) can be lightly applied to the wound before bathing/showering. This protects the area by enabling the water to run off the damaged skin.

• If a crust appears on the nipple-areola, do not pick it or peel it off, as this would remove the pigment as well as the crust.
• Do not sunbathe, swim or use a sauna or jacuzzi during the two weeks following both the first and any follow-up procedures.
• A follow-up appointment will be arranged before you leave after the procedure.

If you require any further information or advice then please contact your breast care nurse.

If you have any problems out of hours or weekends then you can telephone 111 (NHS non emergency contact number).

Data Protection

Any personal information is kept confidential. There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible.

In order to assist us to improve the services available, your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews. Further information is available in the leaflet Disclosure of Confidential Information IL137, via Gateshead Health NHS Foundation Trust website or the PALS Service.