Tattooによる乳頭・乳輪再建—パラメディカルによる実施の現状と3D tattooのテクニック—

Nipple And Areola Reconstruction Using Tattoos: The Current Status According to Paramedical Practice and 3D Tattoo Techniques

はじめに

　乳癌は年間10万人が罹患し，そのうち半数が乳房全摘術を受けている。また，乳房全摘術を受けた患者のうち，10.4 ％が乳房再建術を受けている 1）。シリコンインプラント，もしくは広背筋皮弁や腹直筋皮弁など自家組織を用いて乳房の再建が行われた後，乳頭・乳輪の再建が行われる 2）3）。乳頭は健側からの半切乳頭移植または局所皮弁により作成され，乳頭作成のための侵襲的な手術を躊躇する患者には，乳頭が立体的に見えるようにアートメイクを施す方法もある。本稿では，乳房再建後，アートメイクのみで乳頭・乳輪を作成する方法（以下，3D乳頭・乳輪アートメイク）について解説する。

　In breast reconstruction after breast cancer surgery, reconstruction of the nipple and areola is often performed as the final step. The nipple is created by the composite grafting of a half-cut nipple from the healthy side or by using local skin flaps, and the areola is often reconstructed by grafting pigmented skin from the base of the patientʼs inner thigh or by tattooing. However, for patients who are hesitant to undergo invasive surgery for the creation of a nipple, there is also a method of applying permanent makeup to make the nipple appear three-dimensional (3D). We explain how to create a nipple and areola using only permanent makeup after breast reconstruction. Pigments are injected into the superficial layer of the dermis with the use of a tattoo machine or hand carving, but by bringing the breast close to the healthy-side nipple and areola to compare color tones, fine uneven shadows, and organs, it is possible to increase symmetry and patient satisfaction. Although this technique is difficult, it is minimally invasive for the patient, and we believe that the number of cases in which this technique is applied will increase in the future.