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27.25 Nipple tattooing

Essential equipment

  • Antiseptic skin cleaning agent (Sterets Tisept Sachets) 0.015% and 0.15% w/v cutaneous solution chlorhexidine gluconate cetrimide
  • Sterile dressing pack
  • Sterile gloves
  • Plastic apron
  • Sterile scissors
  • Surgical marking pen
  • Areolar stencil
  • Pigments
  • Needle cartridge for tattooing
  • Hand piece for holding tattoo needle
  • Medical tattoo machine (Figure 27.48)
  • Cotton bud
  • Mepilex Border Sterile dressing 7 × 7.5 cm

Medicinal products

  • EMLA cream

Pre‐procedure

ActionRationale

  1. 1.
    Explain and provide written information about the nipple tattoo procedure.
    To ensure the patient is properly informed about the procedure (DH [80], C; NMC [199], C).
  2. 2.
    Obtain written informed consent.
    To enable patients to actively participate in and comply with their treatment (NMC [199], C).
  3. 3.
    Match colour a slightly lighter shade after discussion with the patient. Mix pigment colour.
    To ensure a close match to existing breast. E
  4. 4.
    Apply EMLA cream for 40 minutes to tattoo site.
    To minimize pain during the areolar tattooing procedure. E
  5. 5.
    Prepare the procedure trolley and ensure that all the necessary equipment is readily available (Figure 27.49).
    To ensure the procedure is performed efficiently and correctly. E
  6. 6.
    Ensure patient privacy by drawing the curtains and making use of a sheet or blanket.
    An environment that facilitates the patient's need for privacy and dignity is essential for areolar tattooing (NMC [202], C).
  7. 7.
    Assist the patient into the correct position.
     

Procedure

  1. 8.
    Open the pack and then open all the equipment onto the sterile field.
    To maintain asepsis throughout the procedure to minimize the risk of infection (Fraise and Bradley [106], E).
  2. 9.
    Wash hands and apply sterile gloves.
    To maintain asepsis throughout the procedure to minimize the risk of infection (Fraise and Bradley [106], E).
  3. 10.
    Reassure and observe the patient throughout the procedure.
    To allay anxiety and facilitate the patient's maximum co‐operation. P
  4. 11.
    Clean the skin thoroughly at the tattoo site with an antiseptic solution, for example chlorhexidine 0.5% and alcohol solution and allow to dry.
    To maintain asepsis throughout the procedure to minimize the risk of infection (Fraise and Bradley [106], E).
  5. 12.
    Commence the procedure with gentle circular movements, stretching the skin with the other hand.
    Lightly feather around the areolar edge to give a natural finish.
    To achieve a natural result. P
  6. 13.
    Cover the areola in pigment at least three times.
    To give best results. P
  7. 14.
    Check the pigment uptake by removing the excess pigment with clean gauze. Repeat as necessary to check area of uptake.
    To achieve a consistent result. P
  8. 15.
    Apply yellow soft paraffin to areola.
    To prevent pigment drying. E
  9. 16.
    Apply a sterile dressing.
    To achieve haemostasis and decrease the risk of infection at the tattoo site. E

Post‐procedure

  1. 17.
    Dispose of sharps as per local policy.
    To ensure the safe handling and disposal of needles and other sharp instruments and to protect staff, patients and visitors from exposure to bloodborne pathogens (DH [81], C; Loveday et al. [151], C)
  2. 18.
    Record the necessary information in the appropriate documents as per local policy.
    To maintain accurate records (NMC [202], C).
  3. 19.
    Ensure the patient has returned to pre‐procedure functional status before discharge.
    To ensure the safe management and recovery of patients receiving sedation. E
  4. 20.
    Give the patient appropriate aftercare instructions (see Education).
    To ensure the safe management of patients and to enable them to actively participate in and comply with their treatment (NMC [199], C).
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