Impact of nipple–areola complex micropigmentation on quality of life, body image, and sexuality among women after mastectomy: a mixed-methods study

PURPOSE: To evaluate changes in quality of life, body image, and sexual well-being following nipple-areola complex micropigmentation in women who had undergone mastectomy and breast reconstruction. METHODS: A mixed-methods study with a pre-post, analytical, longitudinal, and prospective design was conducted in a final sample of 18 women who had undergone mastectomy and subsequent breast reconstruction. Quantitative data were collected using validated quality-of-life questionnaires administered before and after micropigmentation. Qualitative data were collected using a structured questionnaire with 13 open-ended questions and analysed using thematic analysis. RESULTS: Significant pre-post changes were observed in global health status, emotional functioning, and body image, together with changes in sexuality-related dimensions. Qualitative findings described improvements in body perception, emotional well-being, confidence, and comfort in intimate and social contexts. Participants also identified informational, geographical, economic, and emotional barriers to accessing the procedure. CONCLUSION: Quantitative and qualitative findings showed convergent changes in quality of life, body image, emotional well-being, and sexual well-being following nipple-areola complex micropigmentation. However, the uncontrolled single-group pre-post design does not allow causal inference. Further comparative studies with larger samples, longer follow-up, and greater population diversity are needed to strengthen the evidence regarding the effectiveness and longer-term impact of nipple-areola complex micropigmentation.