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To Ablate or Not to Ablate: Does Umbilectomy Decrease Donor-Site Complications in DIEP Flap Breast Reconstruction?

Kevin Perez1, Sumeet S Teotia1, Nicholas T Haddock1

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Plastic and Reconstructive Surgery
|May 11, 2023
PubMed
Summary
This summary is machine-generated.

Umbilical excision in deep inferior epigastric perforator (DIEP) flap breast reconstruction reduces abdominal donor-site wounds but increases seroma risk. Discussing umbilectomy with patients is recommended, exploring other methods to manage seroma.

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Area of Science:

  • Plastic Surgery
  • Reconstructive Surgery
  • Breast Reconstruction

Background:

  • Deep inferior epigastric perforator (DIEP) flap breast reconstruction is a common autologous procedure.
  • Optimizing outcomes in DIEP flap surgery remains an area of active research.
  • The role of umbilectomy in abdominal donor-site complications requires further evaluation.

Purpose of the Study:

  • To evaluate the impact of umbilectomy on abdominal donor-site complications in DIEP flap breast reconstruction.
  • To compare postoperative outcomes between patients who underwent umbilectomy versus umbilical preservation.

Main Methods:

  • Retrospective study of 408 patients undergoing DIEP flap breast reconstruction.
  • Data collected between January 2015 and December 2021.
  • Primary outcome: abdominal donor-site complications; Secondary outcome: treatment of complications. Covariates included demographics, comorbidities, cancer treatment, and smoking.

Main Results:

  • Umbilectomy (n=194) was associated with fewer total wounds per patient compared to umbilical preservation (n=214).
  • Umbilectomy decreased the risk of any reported abdominal wounds (OR, 0.530; P = 0.009).
  • Umbilectomy increased the risk of donor-site seroma (OR, 5.761; P = 0.016), though risks of wound separation and partial necrosis trended lower.

Conclusions:

  • Umbilectomy should be considered in DIEP flap breast reconstruction due to reduced wound complications.
  • The increased risk of seroma with umbilectomy necessitates further investigation into management strategies.
  • Progressive tension sutures may be explored to mitigate seroma formation and enhance wound healing.