Medical Tattooing Research Articles

Breast Cancer Survivors' Perceptions of Mastectomy Reconstruction: A Comparative Analysis of Medical Tattooing Impact on Aesthetics.

Studies indicate that physical appearance changes affect a significant proportion of breast cancer survivors, often leading to post-surgical distress. Both reconstructive surgery and medical tattoos are associated with patient-reported satisfaction, yet further research is necessary to understand their combined impact on aesthetic outcomes from the patient perspective. This study examined how breast cancer survivors evaluated the cosmetic and decision satisfaction of other patients who made various cosmetic intervention choices post-mastectomy. Breast cancer survivor support networks (n = 180) across 20 states agreed to share information about the online survey to their members. Participants (n = 251) rated the cosmetic outcome and decision satisfaction of images depicting other patients who had received mastectomy with three types of intervention: reconstruction alone, medical tattooing alone (flat closure), and reconstruction and medical tattooing combined. A factorial MANOVA produced significant within-subjects effects indicating participants consistently rated images of patients with a combination of reconstruction and medical tattooing highest in cosmetic quality, lowest in scar visibility, and highest in treatment decision satisfaction. The findings suggest that medical tattooing serves as a valuable complementary cosmetic intervention, with many survivors expressing interest and recognizing potential benefits once informed about the option. However, the study's limitations, such as the need for a more diverse range of patient images for evaluation, should be acknowledged. Future research should address these gaps by incorporating photographs of patients across varying demographics, including age, body weight, disease severity, and surgical procedures, to minimize bias. Despite these limitations, this study highlights the significant role that medical tattooing can play in enhancing aesthetic outcomes after surgery, particularly from a patient-centered perspective. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://link.springer.com/journal/00266 .

Medical tattooing as a complementary cosmetic intervention to reduce body-image distress and mental health symptoms in U.S. breast cancer survivors.

A review of the literature revealed a high incidence of body-image distress among breast cancer survivors who had surgery. This cross-sectional study examined the relationship between medical tattooing as a complementary cosmetic intervention and body-image distress and mental health outcomes among breast cancer survivors following surgery. We examined 330 post-surgical breast cancer survivors collected through a nationwide online survey in the U.S., pursuing two main objectives. First, we investigated body-image distress, depression and anxiety symptoms, and perceived stress in survivors who underwent breast cancer surgery, comparing those with medical tattooing (n = 89) and those without (n = 226). Second, we assessed the influence of the participant's surgery type on body-image distress, depression and anxiety symptoms, and perceived stress. Additionally, we evaluated whether individual factors, such as appearance investment, satisfaction with decision, and cosmetic expectation discrepancy, predicted the participant's body-image distress. Findings suggest that participants with medical tattoos reported significantly lower body-image distress, depression and anxiety symptoms, and perceived stress compared to those without medical tattoos. The participant's surgery type did not significantly predict body-image distress, depression or anxiety symptoms, or perceived stress. However, participants who reported greater appearance investment endorsed higher body-image distress. Participants who reported higher satisfaction with their treatment decisions and lower cosmetic expectation discrepancy endorsed lower body-image distress. Medical tattooing may be a valuable tool in improving body-image distress and mental health for those who wish to pursue it, but more research is needed. Empirical studies supporting the mental health benefits of medical tattooing among survivors are crucial to standardize insurance coverage and promote its inclusion as a complementary intervention across insurance providers nationwide. This complementary intervention should be considered using a patient-centered approach that aligns with the patient's values and preferences.

Abstract PO3-28-02: BODY-IMAGE DISTRESS IN BREAST CANCER SURVIVORS AND THEIR EVALUATION OF MEDICAL TATTOOING FOLLOWING SURGERY

Abstract A review of the literature reveals a high incidence of body-image distress among breast cancer survivors who have undergone surgery, which is a natural response to the significant changes in their appearance. Reconstructive surgery, utilizing implants or flaps, may be employed to restore breast size and shape. Medical tattooing can recreate the nipple-areola complex and decorative appliques can conceal scars and skin color variations. Both reconstructive surgery and medical tattoos are associated with patient-reported satisfaction, yet further research is necessary to understand their combined impact on body-image distress. To investigate this, a survey was distributed among national breast cancer support groups and advocacy organizations, yielding 207 responses from individuals meeting the study's criteria. The participants were categorized into two groups: those who received post-surgical medical tattoos (n = 61) and those who did not (n = 146). The study also examined how participants evaluated the cosmetic and decision satisfaction of patients who made various surgical and cosmetic intervention choices. This was accomplished by having participants rate images of patients who had received three types of intervention: mastectomy and reconstruction only, mastectomy and medical tattooing only, and mastectomy, reconstruction, and medical tattooing. Using linear regression and multilevel modeling that controlled for demographic and clinical factors associated with body-image distress, the findings demonstrated that participants with medical tattoos reported significantly lower levels of body-image distress, depressive symptoms, and perceived stress compared to those without medical tattoos. Furthermore, participants rated images of patients who underwent both reconstruction and medical tattooing post-mastectomy as having significantly higher cosmetic and decision satisfaction ratings than images of patients who received reconstruction or medical tattooing alone. This research expands on our understanding of body-image distress in survivors as a multidimensional construct and may serve to indicate potential means for intervention. Enhancing our understanding of how breast cancer treatment and surgery affects survivors' body-image distress may aid healthcare professionals in offering additional psychoeducation and recommendations. Furthermore, presenting information about medical tattooing as a complementary cosmetic option early in the treatment process allows patients the opportunity to consider it within the context of their overall treatment plan. Table. Linear regression results using BIBCQ as the outcome variable and medical tattoo group as the predictor variable with covariates included. Note. PHQ9 = Patient Health Questionnaire-9. PSS = Perceived Stress Scale. Citation Format: Miranda Proctor, Jeffrey Cassisi. BODY-IMAGE DISTRESS IN BREAST CANCER SURVIVORS AND THEIR EVALUATION OF MEDICAL TATTOOING FOLLOWING SURGERY [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-28-02.

Bright Semiconductor Quantum Dots Shed New Light on Precision Nanomedicine for Various Diseases.

Nanomaterials with diagnostic and therapeutic functions have exciting potential to reshape the landscape of precision medicine. Impressive progress has been made toward the design and production of innovative theranostic nanomaterials that improve disease care, motivated by their ability to simultaneously provide diagnostic information and therapeutic benefits. Herein, the state-of-the-art theranostic semiconductor quantum dots (QDs) are summarized, and the diverse types of QDs designed for the diagnosis and treatment of different diseases are discussed. The opportunities and benefits of QDs are highlighted throughout using in vitro and in vivo examples aimed at addressing various clinical challenges, including cancer, vascular dysfunctions, microbial infections, and medical tattoos. Over the past several years, this area has experienced enormous growth, particularly in preclinical animal imaging and therapy, which has brought the field closer to reaching human patients. Unfortunately, several barriers to clinical translation remain. Therefore, in addition to summarizing the key results from previous in vivo studies, the lessons learned from these studies are synthesized, perspective on the future steps needed for both fundamental studies and the clinical translation of theranostic QD nanotechnology to inform future QD design is provided.

Minimal Scar Autologous Breast Reconstruction with Skin-sparing Mastectomy.

We analyzed 20 patients with unilateral breast cancer who underwent skin-sparing mastectomy followed by immediate breast reconstruction using a free flap (deep inferior epigastric perforator flap in 13 patients and profunda artery perforator flap in seven). Approximately 1 year after primary reconstruction, nipple reconstruction using an arrow flap designed on the skin paddle and resection of the residual skin paddle were performed. Several months later, medical areola tattooing was performed. Bilateral breast symmetry scores, obtained from the distances between anatomic landmarks, were compared before and after breast reconstruction. Postoperative complications such as necrosis of the reconstructed nipple were not observed after two-stage reconstruction, and all procedures including total resection of the skin paddle, nipple reconstruction, and medical tattooing were performed successfully in all cases. Aesthetic outcomes were excellent: comparison of symmetry scores showed no significant differences in any parameters between before surgery and after reconstruction of the nipple-areola complex. We have established step-by-step strategies for mastectomy, autologous breast reconstruction, and then nipple reconstruction, keeping in mind that the skin paddle would later be totally resected in nipple reconstruction, and thereby achieved breast reconstruction with markedly reduced postoperative scarring compared with conventional autologous breast reconstruction.

Cohort profile: The Swedish Tattoo and Body Modifications Cohort (TABOO)

PurposeThe Swedish Tattoo and Body Modifications Cohort (TABOO) cohort was established to provide an infrastructure for epidemiological studies researching the role of tattoos and other body modifications as risk factors...

Patient-Reported Outcomes of Medical Tattooing for Capillary Malformations

Background: Patients with capillary malformations (CMs) may undergo medical tattooing (MT) as an alternative to laser therapy. But little is known about treatment results and impact from the patients’ perspective. Objectives: In this cross-sectional digital survey study, we evaluated the patient-reported outcomes of MT for CMs. Methods: MT practices were identified via the Dutch Association of Skin Therapists and Google. These practices invited all their CM patients who had undergone MT between January 2011 and September 2021 to participate. Baseline and treatment characteristics, tattooing effectiveness, patient satisfaction with treatment outcomes, and complications were evaluated using a custom-made online survey. Quality of life was assessed with the Dermatology Life Quality Index (DLQI) questionnaire. Factors associated with treatment effectiveness and patient satisfaction were identified via bivariate analysis and ordinal logistic regression analysis. Results: Most of the 89 respondents were female (69%). Almost all CMs were located on the face (90%) and mainly (dark) red (74%). Nearly all patients had undergone laser therapy (91%). Median number of tattooing sessions was 5 (IQR: 4.0–8.0). Thirty-seven percent of the patients perceived >75% color reduction. Younger patients were more likely to obtain lower treatment effectiveness (OR 0.44, 95% CI: 0.20–0.97). Most patients (83%) were satisfied with treatment results. Patients with lighter (OR 0.30, 95% CI: 0.13–0.72), non-facial (OR 0.15, 95% CI: 0.03–0.89), and hypertrophic CMs (OR 0.30, 95% CI: 0.11–0.82) were less likely to be satisfied with treatment outcomes. Patients with lighter skin types were more satisfied (OR 2.89, 95% CI: 1.23–6.80). Complications included transient pain (23%), bleeding (3.4%), hypertrophic scarring (1.1%), hypopigmentation (1.1%), and a halo around the tattoo (1.1%). Conclusion: MT seems a valid alternative treatment in addition to laser therapy for CMs, with mild complications. Most patients are (very) satisfied with treatment results, while color reduction is incomplete. Hence, it seems appropriate to decide together with patients whether or not to use MT as primary treatment or secondary to laser therapy.

Medical Tattooing in Hospital Settings versus Parlors and the Challenging Hygiene Requirements.

The European Union for Standardization called CEN (Comité Européen de Nomalization), as a result of the project named CEN/TC-435 in January 2020, released a new hygiene standard for tattooing as a non-binding recommendation on safe tattoo practice in Europe, ready for national implementation. It describes hygienic standards for facilities, instruments, tattoo ink handling, and tattoo procedures. Informed consent is included. It is generic and covers all sorts of tattooing. Medical tattooing is performed in hospitals, private clinics, and in tattoo parlors. Hospitals have their own settings and hygiene standards. The article describes practical challenges of medical tattooing performed in hospital settings, with medical tattooing performed in parlors as the reference, with respect to adherence to hygiene standards of different background and nature. It is a challenge possible to overcome in practice. The specialized field of medical tattooing is also visited, and indications and precautions described.

Auxiliary Utensils in Cosmetic and Medical Tattoo Settings.

Cosmetic and medical tattooing is miniaturized tattooing of high precision and thus requires many dedicated utensils including advanced devices for marking and anatomical delineation. Symmetry is a special demand, as is aesthetic outcome, building on perfectionated detail. The artist shall master design and strategy along with advanced technical performance helped by having and using the right tools. This article reviews and illustrates the many special utensils involved in good-practice cosmetic and medical tattooing, exemplified by selected tools used for cleansing, disinfection, pre-operative measurement and marking, and special tattoo machines, cartridges, microblades and needles. Personal protective equipment used to prevent infections among technicians and customers are also illustrated. Educational tools, such as face phantoms and eyebrow mats, are displayed. Mastering cosmetic and medical tattooing is a challenge and involves mastering the many auxiliaries along with needle configurations, machines, inks and the whole setting of the activity. This review is an illustrated practical record and a guideline to good professional practice.

Cosmetic and Medical Tattoos, National and International Regulatory Requirements on Instruments and Commercial Ink Stock Products.

This chapter explains the international regulative framework on equipment and inks for cosmetic and medical tattooing. In the following text, the word "tattooing" refers to body tattooing, permanent makeup, and microblading. From a global perspective, regulation of equipment for cosmetic (decorative) tattooing, and especially inks, is inconsistent and mainly based on a diversity of national laws. In contrast, regulation of equipment for medical tattooing is subjected to the internationally harmonized medical devices regulation. Even though dermal invasiveness and biological mode of action are identical for cosmetic and medical tattooing, the regulatory requirements are separated in two divergent regulative frameworks.

Psychological and Psychosocial Aspects of Medical Tattoos in Women with Breast Cancer.

The purpose of this chapter is to provide an account of the value granted to the oncologic medical tattoo by those women who have just finished their surgical and plastic breast reconstruction process following a mastectomy. To this end, we conducted in-depth interviews with the beneficiaries of the Aesthetical, Paramedical and Oncologic Micro-Pigmentation Foundation's (FEMPO) free program. Medical tattoos are positively evaluated in connection with post-breast cancer physical reconstruction; they are granted a high value due to the aesthetic effect and the simplicity of the intervention, both in the reconstruction of the areola-nipple complex and the reduction of scars and adverse effects from the adjuvant treatment on hair and eyebrows. Additionally, psychical meanings are granted that add value to the process; it is considered to be the end of a painful process, the recovery of a part of the body that had been lost, and the return to a healthy state. The above is seen as a landmark full of psychological and emotional reparation meanings. Finally, the empathic and close relationship with the team is also positively evaluated, as it helps women feel confident, promoting a caring environment beyond aesthetic considerations.

Needle Configuration and Application in Cosmetic and Medical Tattooing.

Needles, machines, and techniques used for professional cosmetic and medical tattooing have reached a high level of sophistication. Best utensils are combined with operator's insight - the key to best results. Nowadays, a broad range of different tattoo needles serving different purposes are available. The chapter reviews round, flat, triangular, magnum, nano, polished, textured needles, etc. and their coding and preferred use in practice. The chapter is intended to be the vade mecum for practitioners in the field, the newcomer as well as the experienced, in private setting as well as in hospital.

Equipment Used for Cosmetic and Medical Tattooing.

This chapter reviews our present knowledge about equipment used for cosmetic (decorative) and medical tattooing and its function with respect to installation of tattoo ink into the skin. In the following text, the word "tattooing" refers to body tattooing, permanent makeup (PMU), microblading, and medical micropigmentation. The major consumer risks related to unsafe tattoo and PMU equipment are reconsidered. Such health risks mainly include the danger of non-sterile needles or needle cartridges, cross contamination of equipment and lack of biocompatibility. Even though state-of-the-art tattoo equipment will support the tattooist to reduce such health risks, also today unsafe equipment still might affect consumer health due to malpractice advertising and fraudulent CE certificates by questionable manufacturers and suppliers not being transparent to parlors and artists. For artists, it is therefore of growing importance to understand how to distinguish well-made safe tattoo equipment from fraudulent unsafe products.

Areola and Nipple Reconstruction in Breast Cancer and Other Conditions.

Medical tattoos are used for camouflage of a wide range of disfiguring skin pathologies and conditions. Recently, tattooing of the nipple and areola of the breast has been introduced as a corrective treatment of sequelae from breast cancer surgery and radiotherapy. The psychologic impact of a disfigured nipple and areola can invalidate self-esteem of the sufferer lifelong with major consequences for social life. Medical tattooing can often restore the visual appearance of the nipple-areolar complex back to normality and even improve the 3D impression of the entire breast. High skills of the operator are needed. The article reviews the theoretical background, patient selection and information, technical performance, and aftercare. Close cooperation between surgeon, dermatologist, and medical tattooist is essential. Medical centers treating breast cancer should routinely have access to corrective medical tattooing.

Camouflage of Vitiligo by Medical Tattooing.

Vitiligo is an acquired skin depigmentation disorder that affects 0.5-2% of the world population. It is characterized by loss of the natural brown melanin pigment of the skin clinically manifested as few or many white patches on the skin and microscopically with the total absence of me-lanocytes in the epidermis. The change in appearance caused by vitiligo can affect persons' emotional and psychological well-being and may cause them to alter their lifestyle. The social complication of vitiligo depends on ethnicity and on geography and local opinion, which may deem vitiligo contagious. The aim of the medical tattooing procedure in vitiligo is to revert the white vitiligo patches to normal-looking skin of natural or near natural color through installation of brownish tattoo pigment. The coloring effect is not permanent and tends to fade over time, and repeated treatment may be needed after about a year. This chapter reviews vitiligo and indications, technique, and procedures associated with medical tattooing of the disease.

Special Applications of Medical Tattooing: Contouring and 3D Exemplified by Tattooing of the Nailbed and the Gingiva.

Medical tattooing aims to restore the normality of skin structures in patients who have skin diseases or suffer sequelae after surgical interventions or hazards. There are numerous applications, with tattooing of vitiligo and the nipple areola complex after breast cancer surgery as leading fields. The use of 3D or realistic tattoo techniques has increased the potential of medical tattooing and improved the aesthetic results. The tattooist must have good technical training combined with artistic and creative talents. In this chapter, two innovative applications of medical tattooing will be presented as examples, i.e. tattooing of the nailbed and the gingiva. Nailbed tattooing reconstructs the normal perception of the nailbed and the nail plate when the nails have previously been removed though a surgical procedure. Tattoo of the gingiva performed after a connective tissue implant of the gum is a new application. These treatments, approved by a physician and performed by a tattooist with proven experience in medical tattooing, also involve the use of specific color nuances that produce an extremely realistic outcome.

The Sudden Rise of Cosmetic and Medical Tattoos on All Continents.

Cosmetic tattooing dedicated to beautifying the normal anatomy such as the eyebrows, the eyelines, or the lips is in a remarkable growth all over the world. Medical tattooing with reconstruction of the areola and the nipple after breast surgery, correction of the lost color of vitiligo and scars is a spin-off, which has made tattooing cross the barrier and become accepted and used in clinics and hospitals in service of the quality of life of patients. The last years have seen a major development of machinery, inks, techniques, experiences, and services. The overwhelming rise of the activity created by client pressure and business opportunity, however, also has its cons: amateur work and even malpractice. The development is driven by elite technicians, but competence is little transparent to clients, and there is no distinct authoritative recognition of practitioners based on a recognized educational curriculum. National regulations of the industry are highly variable and scattered. Some countries have no restriction and in others cosmetic tattoos shall be performed by medical doctors. The challenge of the coming decades is to parallel the success of the industry with quality assurance to better control practices and safeguard clients, and the patients.

Cosmetic and Medical Tattooing: Procedural Planning from A to Z and the Informed Consent.

Cosmetic and medical tattooing are in rapid growth on all continents. The tattoos contribute to self-esteem and quality of life. Clients and patients have many different backgrounds and often highest aesthetic expectations, which the professionals shall meet. In this situation, correct, relevant, and personalized information on effectiveness, technique, procedures, and risks is highly important to reach a shared goal without misunderstanding and conflict. Information and agreement between provider and client are crystalized in the informed consent document. This article reviews the many aspects of pre-procedure client information explained in a book format providing information, which is of direct practical usefulness.

History of Cosmetic and Medical Tattoos.

Tattooing for medical purposes may have been around more than 5,300 years ago, but most of the interest and changes have occurred during the last 100 years as a consequence of scientific advances leading to quicker, cleaner, and less painful insertion of pigment into the skin as well as advances in medical knowledge allowing for more relevant individual information to be transmitted by the embedded pigment. These changes are ongoing. Cosmetic tattooing or tattooing for camouflage of body surface imperfections, likewise, has advanced during the last 50 years concurrently with the rise of social media, internet access, and the popularity of personal electronic visuals.

Psychological and Social Aspects of Cosmetic Tattoos versus Conventional Cosmetic Care.

Cosmetic tattoos are in the same family as medical tattoos and conventional cosmetic care and fall within the overall concept of body modification. Each discipline has its own segment of users and its own techniques and professional providers. However, they all serve the higher aim of shaping the skin and the body and improving image and self-esteem.