Although nipple-areola tattooing is now a well-accepted step in breast reconstruction, little is known about its long-term effectiveness. A retrospective study of our 6-year experience in tattooing 151 patients was thus carried out. Patients were surveyed regarding color match, satisfaction, and complications. Follow-up ranged from 1 to 75 months (mean, 25.2 months). Fifty-seven percent of respondents said their tattoo looked similar to the normal areola. There were five (3%) infections, one rash, and one slough. Ten percent of tattoos needed a touch-up later to correct for excessive fading. Nearly 60% of tattoos were ultimately lighter than the normal. Eighty-four percent of the tattoos were rated as satisfactory, and 86% of the patients said they would repeat the procedure if given the same choice again. Nipple-areola tattooing done with iron oxide and titanium dioxide pigments thus appears to be a reasonably safe and effective procedure in most patients but may require one or more subsequent touch-ups for appropriate color match.