Tattoo or reconstruction? Sixteen-year trends in post mastectomy nipple areolar complex restoration in the United States.

Breast cancer is the most frequently diagnosed cancer in women worldwide, and mastectomy often necessitates restorative approaches to preserve cosmetic outcome and quality of life. Nipple-areolar complex (NAC) reconstruction and tattooing are among the most widely described techniques; however, their relative use at the national level remains poorly defined. Using International Classification of Diseases, 9th and 10th revision (ICD-9 and ICD-10) and Current Procedural Terminology (CPT) codes, national data from 2007 to 2023 were analyzed to identify cases of NAC reconstruction and tattooing. Logistic and quasi-Poisson regression was applied to evaluate NAC procedure trends stratified by breast reconstruction type. Surgical NAC reconstruction and tattooing declined annually by 6.5% and 5.8%, respectively (p < 0.001). The downward trends persisted for both NAC restoration types during subgroup analysis among patients who received implant-based autologous and hybrid breast reconstruction (p<0.001). These findings suggest a shifting paradigm in NAC restoration, with evolving preferences and surgical techniques. The observed trends have implications for patient counseling, surgical planning, and shared decision-making to help patients achieve their reconstructive goals.