Meaning, Identity, and Practice in Nipple-Areola Complex Tattooing Among Breast Cancer Survivors: A Scoping Review With a Data Mining Approach

Background: Nipple–areola complex (NAC) tattooing is an increasingly important component of breast reconstruction after mastectomy, supporting both aesthetic restoration and psychosocial recovery. However, NAC tattooing practices remain heterogeneous, with limited evidence on standardized protocols, nursing roles, and patient-reported outcomes. Objective: This scoping review aimed to examine the clinical, psychosocial, professional, and organizational aspects of NAC tattooing in post-mastectomy care. Methods: Following Joanna Briggs Institute and PRISMA-ScR guidelines, we systematically searched PubMed, Scopus, CINAHL, and EMBASE, supplemented by grey literature. Eligible studies addressed NAC medical tattooing for women undergoing breast reconstruction in any clinical setting. Data were extracted on study characteristics, professional roles, care models, psychosocial outcomes, and use of validated assessment tools. Computational analyses, including topic modeling, sentiment analysis, and multiple correspondence analysis, were conducted to identify thematic clusters and geographic patterns. Results: Sixty-nine studies met inclusion criteria. The literature predominantly emphasized technical and aesthetic aspects, with minimal standardization in psychosocial assessment. Nurses were primarily associated with patient support, counseling, and nurse-led services, while surgeons were linked to procedural roles. Marked geographic and organizational variability emerged, with inconsistent reimbursement practices and few economic evaluations. Validated patient-reported outcome measures, such as the BREAST-Q, were rarely employed. Conclusions: NAC tattooing is a promising, minimally invasive intervention within survivorship care. To optimize patient-centred outcomes and equitable access, future efforts should focus on standardizing protocols, implementing validated psychosocial assessments, and expanding nurse-led integrative care models.