Can Montgomery tubercles impact aesthetic 3D nipple-areolar complex tattooing? An anatomical, quantitative analysis of breast cancer patients

Published:November 08, 2022DOI:


      • Reconstruction of the NAC is integral to breast reconstruction, increasing multiple quality-of-life domains.
      • A variety of techniques may be employed to reconstruct the NAC, including local grafts, flaps, and 3D NAC tattooing.
      • Despite the importance of NAC reconstruction, scant studies have examined the influence of patient characteristics on NACs.
      • Our study suggests that NAC projections, termed Montgomery tubercles, are influenced by menopausal status.
      • 3D NAC tattoo artists may consider menopausal status when deciding quantity of Montgomery tubercles for an aesthetic tattoo.



      We aimed to establish a relationship between the amount of Montgomery tubercles (MTs) per nipple-areolar complex (NAC) given patient characteristics such as age, BMI, menopausal status, race/ethnicity, and NAC size to better inform current 3D NAC tattooing practices.


      Preoperative photographs of patients pursuing breast reconstruction after mastectomy in 2010 through 2018 were reviewed. The number of MTs on each native NAC was quantified. The impact of patient factors on the quantity of MTs was evaluated via Pearson correlation and bivariate analyses.


      Two hundred and eleven patients (399 breasts) were reviewed. On average, patients had 5.0 ± 5.2 MTs (range, 0–25 MTs). Number of MTs did not correlate with patient age, BMI, or NAC size. Premenopausal females were more likely than postmenopausal females to have a greater number of MTs per breast (p-value = 0.0183).


      Postmastectomy patients desiring a more “youthful” NAC may consider additional MTs when pursuing 3D NAC tattooing.


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