Aesthetic Evaluation and Validation: Umbilicus Reconstruction after DIEP Flap

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Aesthetic Medicine

Background:

• Deep inferior epigastric perforator (DIEP) flap is the standard for autologous breast reconstruction.
• Umbilicus management options include re-inset, neoumbilicus, or umbilectomy.
• Evaluating aesthetic outcomes and patient satisfaction related to umbilicus reconstruction is crucial.

Purpose of the Study:

• To compare the aesthetic outcomes of different umbilicus management techniques following DIEP flap breast reconstruction.
• To assess patient satisfaction with abdominal appearance based on umbilicus reconstruction methods.
• To determine the optimal approach for umbilicus reconstruction in DIEP flap procedures.

Main Methods:

• Retrospective review of 1,019 patients undergoing DIEP flap breast reconstruction (August 2009 - January 2022).
• Patients categorized by umbilicus management: native re-inset, delayed reconstruction, or no reconstruction.
• Crowdsourced aesthetic preference survey and BREAST-Q scores used for evaluation.

Main Results:

• Delayed umbilical reconstruction received significantly higher aesthetic ratings than native re-inset or no reconstruction (p < 0.001).
• Patients with delayed reconstruction reported comparable satisfaction to the re-inset group.
• Delayed reconstruction showed significantly higher satisfaction and well-being compared to no reconstruction (p = 0.006, p = 0.027).

Conclusions:

• Umbilectomy with delayed reconstruction provides superior aesthetic results in DIEP flap breast reconstruction.
• Delayed reconstruction offers comparable patient satisfaction to native umbilicus re-inset.
• This technique enhances patient satisfaction and well-being regarding abdominal aesthetics post-reconstruction.