Aesthetic Evaluation and Validation: Umbilicus Reconstruction after DIEP Flap.

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, neo-umbilicus, and umbilectomy without reconstruction. This study evaluated the aesthetic differences in umbilicus reconstruction choice and variation in patients' post-operative satisfaction with their abdomen.

METHODS: A retrospective review of 1019 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 crowd-sourced survey was created to assess the aesthetic preference of each photo using a Likert scale.

RESULTS: There were 1063 responses to the umbilicus preference crowdsource survey. Patients who had delayed umbilicus reconstruction after umbilectomy were rated significantly more attractive (4.397 ± 1.697) than both preservation of the native umbilicus (4.176 ± 1.669) and the lack of umbilicus (3.994 ± 1.733) (p < 0.001, p < 0.001, respectively). In an analysis of 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 to the no reconstruction group (p = 0.006, p = 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.