Abstract
Background The most common method for autologous breast reconstruction is the deep inferior
epigastric perforator (DIEP) flap. The umbilicus can be managed in various ways, including
re-inset, neoumbilicus, and umbilectomy without reconstruction. This study evaluated
the aesthetic differences in umbilicus reconstruction choice and variation in patients'
postoperative satisfaction with their abdomen.
Methods A retrospective review of 1,019 patients treated with DIEP flap breast reconstruction
between August 2009 and January 2022 was conducted. Patients were stratified by management
of the umbilicus: preservation and re-inset of the native umbilicus, umbilectomy with
delayed reconstruction, and umbilectomy with no reconstruction. A crowdsourced survey
was created to assess the aesthetic preference of each photograph using a Likert scale.
Results There were 1,063 responses to the umbilicus preference crowd source survey. Patients
who had delayed umbilicus reconstruction after umbilectomy were rated to be significantly
more attractive (4.397 ± 1.697) than both preservation of the native umbilicus (4.176 ± 1.669)
and lack of the umbilicus (3.994 ± 1.733; p < 0.001 and <0.001, respectively). In an analysis of the BREAST-Q scores, delayed
reconstruction patients had a similar change across measures when compared to the
re-inset group. The delayed group had a significantly higher change in overall satisfaction
and well-being with abdomen when compared with the no reconstruction group (p = 0.006 and 0.027, respectively).
Conclusion This study demonstrates that umbilectomy with delayed reconstruction yields a significantly
higher aesthetic rating and comparable patient satisfaction when compared to re-inset
of the umbilicus.
Keywords
autologous - DIEP - umbilicus
