The impact of nipple–areolar complex micropigmentation on the health of mastectomised breast cancer survivors: protocol for a multi-centre descriptive prospective cohort study.

Introduction: Breast cancer survivors often face physical changes that affect their psychological and social well-being. Among these, the loss of the nipple-areolar complex (NAC) can significantly impact body image, self-esteem, and intimate relationships. To address this, surgical reconstruction techniques have evolved, with micropigmentation or tattooing of the NAC emerging as a preferred method due to its simplicity, natural appearance, and minimal invasiveness. Methods: This study is a multi-centre, descriptive, prospective cohort study conducted in Spain. It aims to evaluate the impact of NAC micropigmentation on body image, self-esteem, sexual function, and partner interaction among mastectomised breast cancer survivors. Participants will be women over 18 who have undergone mastectomy and are receiving NAC micropigmentation for the first time. They must have a good understanding of Spanish and internet access. Exclusion criteria include prior NAC tattooing, pregnancy, breastfeeding, or refusal to participate. An initial pilot phase involving 30 participants was used to estimate the necessary sample size. Power calculations based on these preliminary data established a recruitment target of 164 participants Recruitment is consecutive, and ethical approval has been obtained from all participating hospitals. Conclusion: The study addresses a critical gap in post-mastectomy care by focusing on the final phase of breast reconstruction. It highlights the growing popularity of NAC micropigmentation and its potential to enhance psychological recovery and quality of life. Findings may inform future clinical practices and improve patient satisfaction in breast cancer care.