Abstract / Summary
Abstract Background The long-term residual changes to the nipple-areola complex (NAC) following nipple-sparing mastectomy are most frequently reported as hypopigmentation or a pigment disorder related to scarring. Despite successful oncological and reconstructive treatment, these sequelae can persist and continue to affect patients' perception of their bodily integrity. NAC medical tattooing has been described as a method for concealing scars, discolouration, and pigment loss. However, persistent greenish or grey post-ischaemic areolar discolouration has not been clearly documented as a typical long-term NAC outcome. This paper reports on a stepwise chromatic correction, led by nurses, of an uncommon, stable greenish post-necrotic areolar scar. Case presentation A 50-year-old woman underwent NAC-sparing mastectomy with a pedunculated flap following a breast cancer diagnosis. Superficial NAC ischaemia was noted during the initial follow-up visits. Although it was promptly treated with enoxaparin and dressings, a loss of substance was observed in the lower section of the NAC. This was treated with an antimicrobial wound dressing until complete healing was achieved. Although the reconstructive process was successfully completed, the difficult healing process resulted in areas of hypopigmentation and a greenish/grey discolouration. In February 2026, the patient was referred to the ARCADE nurse-led NAC tattooing clinic of the Plastic Surgery Service of the Health Local Authority of Reggio Emilia (Italy). The aim was to neutralise the green/grey colour and make the entire areola uniform by reproducing the original colour. During the initial session, the specialist nurse used a dermograph with a sterile needle and bioabsorbable pigments to apply a pure orange corrector to neutralise the greenish colour. The subsequent two sessions, 30–40 days apart, aimed to harmonise the colour using a graduated approach with rose and brown pigments. The final result was satisfactory, with the greenish area completely corrected and the entire areola harmonised to present a natural appearance. Conclusion Advanced nursing care successfully treated uncommon greenish areolar post-necrotic scar tissue following breast cancer surgery. This case study presents an unusual clinical scenario and adds valuable information to the literature on personalised NAC dermopigmentation following breast cancer surgery.