Nipple-By-Number Shows Promise for Performing 3D Nipple-Areola Tattoo Reconstruction


The device allows plastic surgeons and other supervised specialists to ensure consistently superior, realistic, and customizable results for nipple-areola complex tattooing.

A device called nipple-by-number now allows plastic surgeons and other supervised treating specialists to inexpensively, efficiently, and expeditiously perform 3- and 4-dimensional nipple-areola complex tattooing in their office, according to a report published in Plastic and Reconstructive Surgery.1

This device herein eliminates the need to outsource the service and ensures consistent results on any breast mound, regardless of whether or not a nipple projection procedure has been previously performed. 

“The device allows a more facile and efficient approach by allowing those not skilled in the freehand artistic techniques of light and shadow to create a 3D recreation of the NAC,” the authors wrote. “In addition, it allows the user to create uniform shape, color, and tone in a paint-by-number approach by tattooing within prefabricated windows.” 

The researchers administered a questionnaire to 15 major US metropolitan areas, recording results from 753 plastic and reconstructive surgery offices to assess the services provided, referral patterns, demographics of tattoo providers, location where tattooing is performed, and costs of service. Of the offices that already provided breast reconstruction services, 23% (n = 173) neither perform nor refer patients for tattooing. Additionally, 60% (n = 452) of plastic and reconstructive offices do not perform breast reconstruction and do not refer patients for tattooing. It was also discovered that when these offices do refer a patient to another plastic and reconstructive office, 3% lead to dead-end referrals (i.e. the office cannot perform or refer for tattooing). 

Moreover, approximately 32% of all tattooing is performed in the provider’s office, with merely 11% of tattooing performed by tattoo artists or aestheticians being supervised within a physician’s office. Only 21% of tattooing was performed by physicians and 9% was performed by allied health professionals. Notably, the national average for out-of-pocket costs to the patients are $640 and $956 for unilateral and bilateral tattooing in the US, respectively.

“The nipple-by-number device will decrease the number of patients who are left to independently find a safe and skilled tattoo artist to complete their breast reconstruction and aid more plastic and reconstructive practices in providing this important service,” the authors wrote.

The nipple-by-number device is made up of multiple, removable stencil layers of three-dimensionally-printed plastic with customizable holes to allow for well-controlled and precise tattooing during coloring, shading, and highlighting. Patients determine whether they would prefer the anatomy of the areola to be standard or customized through photographs then, using a Tegaderm dressing to keep the device in place, the layers of the stencil are applied gradually as the various structures are tattooed. 

The researchers hope their tool will aid in making the option of 3D nipple tattooing more widely available for women who have undergone breast reconstruction, according to a press release.2


1. Azouz S, Swanson M, Omarkhil M, Rebecca A. A Nipple-Areola Stencil for Three-Dimensional Tattooing: Nipple by Number. Plastic and Reconstructive Surgery. doi:10.1097/PRS.0000000000006398. 

2. ‘Nipple By Number’ Device Helps Plastic Surgeons Perform 3D Nipple Tattoos [news release]. Published December 26, 2019. Accessed January 21, 2020. 

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