The feasibility of a complex intervention, a medical tattooing nurse-led clinic after breast cancer surgery: results from the ARCADE_M mixed-methods study

Medical tattoos after breast cancer surgery are a therapeutic approach to regain psychophysical integrity. The tattooing of the Nipple-Areola Complex (NAC) in the ARCADE clinic involves three sessions, 30–40 days apart, and specialized nurses perform it upon medical indication. This study aims to assess the feasibility of a NAC tattooing clinic for women who have undergone surgical treatment for breast cancer in the Comprehensive Cancer Center of Azienda USL–IRCCS di Reggio Emilia, in Italy. This project is guided by the Medical Research Council framework for the development and evaluation of complex interventions, focusing specifically on the feasibility phase. The objectives of this phase include assessing organisational sustainability through retrospective analysis of activity data (Endpoint 1); evaluating the NAC tattoos’ quality, by selecting a panel of experts that scored photographs’set, in a 1–5 Likert scale (Endpoint 2); exploring the professionals’ perceptions on their involvement in the clinic, through a qualitative study with semi-structured interviews (Endpoint 3). Endpoint 1: The activity had a standard character in timing and materials. 100% of the sample (N = 33) gained a satisfactory cosmetic result, without adverse events, or other complications like excessive color fading or pain (none or mild for 79%). Endpoint 2: 22 sets were retrospectively retrieved and included in the analysis. The tattooed NACs demonstrated excellent quality, achieving a medium score of 4.7 for color similarity and symmetry, and 4.8 for 3D effect. Endpoint 3: Five professionals (two nurses, one surgeon, two managers) were interviewed. The main macro-themes acknowledged considerations about the value of the clinic, the barriers and the facilitators encountered, and the related future needs. A nurse-led NAC tattooing clinic is a feasible, complex intervention for breast cancer care. The combination of the retrieved data analysis and those generated by the qualitative approach underlines how resource availability and personnel motivation are influential in determining goal achievement, as well as accountability promotion and competence development. The implementation of this service empowered a support network by engaging the community and professionals in collaborative efforts to provide this final step of care, which can be determinant for psychophysical recovery.