3D AREOLA/NIPPLE PIGMENTATION

 

One of the final steps following mastectomy is the reconstruction of a pigmented areola nipple complex , usually referred to as  3D Areola Tattooing. This artistic technique enables the micropigmentation technician to add the finishing touches and fully transform the reconstruction into a breast that patients can be happy to call their own and aiding them to move forward in life with their restored sense of femininity.

Creating a new areola isn't as simple as drawing a circle of color on a breast, it entails careful consideration of areola positioning in relation to the breast shape and contour, picking the right colors to complement the patient's skin tone and realizing the illusion of nipple protrusion to add realism.

Areola Nipple Tattooing is a safe procedure with a high satisfaction rate.  It can be a single session procedure however multiple sessions may be required, and this varies by patient.  As with all tattooing procedures, a follow up visit is mandatory 6 weeks post procedure. Color retention can be affected by radiotherapy, existing scar tissue, medications and other existing medical issues. It is important to discuss the possibility of additional sessions so that patient's expectations can be managed accordingly.

The Procedure

Prior to commencing, we will go over your medical history in detail. We will discuss surgery and treatments you have had or have planned for the future.

During the design phase we take photographs, go over any requests you may have and proceed to draw your new areola/nipple onto your skin.  We want the results to be to your satisfaction and want you to be fully involved in the process.

We then proceed to work on color selection.

For bilateral breast reconstruction cases, we can use a custom blend of pigments to create a color that nicely complements your skin tone or we recreate the color based on your pre-mastectomy photos

For unilateral breast reconstruction cases, we can use a custom blend of pigments to recreate a color that closely matches your existing nipple areola color

We want you to be completely satisfied with the results therefore depending on the look you are after, we can custom blend our colors to match your requirements.

The treatment itself involves the implantation of small particles of pigment into the reticular layer of the skin and typically takes 2 to 3 hours to complete. It is virtually painless but in some cases if needed, a topical anesthetic is applied if the client experiences sensitivity.

 

YOUR RIGHTS

The Women’s Health and Cancer Rights Act of 1998 requires insurance companies  to cover post mastectomy reconstruction, including areola/nipple tattooing. Insurance companies may reimburse some of the cost of the procedure but this is not guaranteed and it is up to the patient to submit the claim post procedure.

If looking for coverage it is advised that you contact your provider prior to your procedure to inform them you are in the process of preparing for Paramedical Micropigmentation to finalize your reconstruction post mastectomy due to breast cancer and inquire if Pre authorization is required and request a Predetermination of Procedure Benefit Allowance.

Insurance companies requirements may vary, therefore when speaking to them be sure to ask all pertinent information needed to facilitate your claim, however at minimum they usually require the following turned in:

 

•  A prescription from your doctor with ICD-10 and CPT codes    
• A claim reimbursement form which is found on their specific website
•  A receipt of payment from the facility where the procedure was performed
•  A letter of medical necessity provided by your doctor  
•  Your health history form filled out at your visit        
•  If prior authorization is required you will need the codes on your prescription  
  
• Before/after photos are recommended to facilitate the process

Procedure and Diagnosis codes information necessary for pre-authorization and for claim reimbursement

PROCEDURE CODES

11921 (Unilateral) Tattooing and intradermal introduction of insoluble opaque pigments to correct color defects, including micropigmentation, 6.1 to 20.1 sq cm

11922 (Bilateral) Tattooing and intradermal introduction of insoluble opaque pigments to correct color defects, including micropigmentation, each additional 20.0 sq cm, or part thereof (list separately in addition to code for primary procedure)

DIAGNOSIS CODES
Z80.3 Family History of Malignant neoplasm of breast

Z85.3 Personal History of Malignant neoplasm of breast

Z90.11 Acquired absence of Right breast and Nipple

Z90.12 Acquired absence of Left breast and Nipple

Z90.13 Bilateral

N65.1 Breast Asymmetry on native breast or disproportion of reconstructed breast

N65.0 Deformity of reconstructed breast

 

POST PROCEDURE AND AFTERCARE

While we strive for perfection on every procedure, results cannot be guaranteed to be perfect after the initial procedure due to the many factors affecting both integration and retention of pigments in the skin. Permanent and Reconstructive Cosmetic makeup procedures are directly affected by the skin that they are performed on.

Factors ranging from medications, sun exposure, smoking, hormones and age all contribute to fading and must be taken into account during pre and post procedure.

A finishing session must be scheduled between 45 to 90 days after your initial procedure to attain the best results and to keep your procedure looking its best.

Please refrain from altering the post procedure protocol advised, use only ointments and creams provided or recommended by Avarté.

HEALING PROCESS

A transient redness is expected immediately following the procedure.  The result will tend to look darker in appearance but will lighten considerably after a few days and gradually settle over the next few weeks.

After the peeling has ended, you may notice the area to have a waxy appearance, this is normal and part of the process.

Don't be alarmed if it fades more than was expected, this can happen and it's normal, thus why a follow up visit is required to asses color and retention.

Itching is normal and part of the healing process, do not pick nor scratch.

 

AFTERCARE

Day 1-3 Only: For the first 2-3 hrs following pigmentation, gently blot the freshly tattooed area 2-4 times with spring water and a soft gauze pad to remove accumulated lymph on surface. Allow to air dry and apply the ointment provided,  cover the area with a non stick bandage. If the bandage appears to stick to the freshly tattooed area, DO NOT PEEL OFF, proceed to soak the pads until they fall off on their own.

Shower and wash area daily, lukewarm water, mild cleanser. Let air dry or blow dry with cool air.  Apply ointment provided twice daily with a Q-tip or freshly cleansed hands and change non stick bandages. If no seeping of fluid is visible allow the area to breathe as much as possible.

Day 4-10 or until healed: Continue to wash as instructed and apply the ointment twice daily with a Q-tip or freshly cleansed hands. Bandages are generally not generally necessary at this point

NOTE:

Also from day 2 thru healing : Shower with back to water.  Afterwards, lightly pat the areas, wait till completely dry and then re-apply the ointment

Avoid until healed:

• Touching with fingers or picking throughout exfoliation process, you may apply provided ointment with cleansed hands only
  
• Swimming, hot tubs or saunas to avoid infection
• Long hot showers and baths
• Direct sun, self tanners or tanning beds
• Gyms and any activities that would cause heavy perspiring for first week
• Any activities which would get the area dirty
• Any lotions or creams other than the ointment recommended

TAKE NOTICE

Very Important:

If you experience any burning or hurting sensation or visible reaction to aftercare provided, discontinue immediately and call for further directions.

If sensitivity increases or reddish ring appears on the Areola perimeter, you must contact us and your primary care physician immediately.  Antibiotic treatment may be required.

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