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BACKGROUND: Nipple-Areolar Complex (NAC) tattoos are an effective cosmetic solution for creating a finished look following breast reconstruction procedures. However, NAC tattoos are prone to significant fading over time, leading to patients to seek revisions. This study was designed to quantify changes in NAC tattoo appearance over time (Figure 1).
METHODS: A total of 71 frontal images of NAC tattoos taken from January 2007- January 2013 from 39 patients were analyzed retrospectively. Each image was analyzed for color and shape by 5 blinded graders using a novel customized scoring system. Subsequently, each image was analyzed using ColorPic software (Iconico, New York). Red/Green/Blue (RGB) and Hue/Saturation/Value (HSV) color parameters were collected from each image at 2 locations- the center of the tattooed nipple and a medial point on the patient’s skin near the tattooed area. Color quantities were normalized to the skin tone in order to control for variability in lighting. Spearman correlations and non-linear regressions were calculated in Graphpad Prism version 6.0 for Windows, (Graphpad, La-Jolla CA).
RESULTS: The length of time after most recent tattoo placement inversely correlated with color score (p<0.0001, 95% confidence interval -0.75 to -0.45) and shape score (p=0.0007, 95% confidence interval -0.58 to -0.17). The time following tattoo placement was found to inversely correlate with all recorded color properties (Table 1). Additionally, patient skin saturation negatively correlated with tattoo saturation (normalized to skin) over time (p=0.041). All individual color parameters fit one-phase exponential decay models (Figure 2). Coefficients of the one-phase decay are reported in Table 2. The numbers of days to 1, 2, 3 and 4 half-lives for each of the six color descriptors are reported in Table 3.
CONCULSIONS: The observational findings show that as time passes, the aesthetic quality of the color and shape of the tattoo decline. Based on the one phase decay models, the color qualities of the tattoo approach those of the patient’s skin over time, ultimately reaching a plateau. The half-life of the decay models can also provide valuable clinical insight as to when the tattoo has stabilized. In practice, tattoo colors may be selected that compensate for the inevitable changes that will occur. The results of this study help optimize tattoo color and alleviate the need for NAC tattoo revisions.

Table 1. Correlations between Color and Time (*time in days)

	95% confidence interval	P (two-tailed)
Hue	-0.60 to -0.20	0.0002
Saturation	-0.67 to -0.31	< 0.0001
Value	-0.80 to -0.54	< 0.0001
Red	-0.80 to -0.54	< 0.0001
Blue	-0.82 to -0.58	< 0.0001
Green	-0.75 to -0.45	< 0.0001

Table 2. One Phase Decay

	Y0	Plateau	K	Half Life	Tau	Span	R Square
Hue	12.030	5.494	0.007	100.100	144.500	6.536	0.187
Saturation	58.270	27.420	0.020	33.970	49.000	30.850	0.344
Value	38.720	9.304	0.009	77.500	111.800	29.420	0.421
Red	38.720	9.304	0.009	77.500	111.800	29.420	0.421
Blue	68.280	26.990	0.010	70.660	101.900	41.290	0.516
Green	65.150	27.350	0.012	55.510	80.090	37.800	0.423

Table 3. Color Property Decay (*time in days)

	t1/2 (50%)	2t1/2 (75%)	3t1/2 (87.5%)	4t1/2 (93.75%)
Hue	100.10	200.20	300.30	400.40
Saturation	33.97	67.94	101.91	135.88
Value	77.50	155.00	232.50	310.00
Red	77.50	155.00	232.50	310.00
Blue	70.66	141.32	211.98	282.64
Green	55.51	111.02	166.53	222.04