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J Reconstr Microsurg 2024; 40(06): 443-451
DOI: 10.1055/a-2205-2337
Original Article

Aesthetic Evaluation and Validation: Umbilicus Reconstruction after DIEP Flap

Nicholas T. Haddock
1   Department of Plastic Surgery, University of Texas Southwestern, Dallas, Texas
,
Cyrus Steppe
2   Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
,
Sumeet S. Teotia
1   Department of Plastic Surgery, University of Texas Southwestern, Dallas, Texas
› Author Affiliations
Funding None.
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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

Supplementary Material



Publication History

Received: 28 August 2023

Accepted: 05 November 2023

Accepted Manuscript online:
07 November 2023

Article published online:
20 December 2023

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