LAUSR

OBJECTIVES There have been several considerations made in improving outcomes for DIEP flap breast reconstruction. The aim of this study is to evaluate the impact of umbilectomy in abdominally based breast reconstruction. METHODS This is a retrospective study that evaluated post-operative outcomes of patients who underwent DIEP autologous flap breast reconstruction at an academic center between January 2015 - December 2021 performed by one of two reconstructive surgeons. Primary outcome variables included abdominal donor site complications. Secondary outcome variables included treatment outcomes for complications. Covariates included demographic information, comorbidities, cancer treatment, and smoking. RESULTS Four hundred eight patients underwent DIEP flap breast reconstruction with one hundred ninety-four (47.5%) undergoing umbilectomy. Umbilectomy resulted in decreased number of total wounds per patient (0.35 ± 0.795) compared to umbilical preservation (0.75 ± 1.322, p < 0.001) as well as decreased associated risk of any reported wounds (OR = 0.530, p = 0.009). Associations that trended towards significance occurred between umbilectomy and minor wound separation, and partial necrosis; both showing decreased risks. Significant association was noted between umbilectomy and donor site seroma (χ2(1) = 6.348, p = 0.016) showing an increased risk (OR = 5.761). CONCLUSION The topic of umbilectomy should be discussed with patients and considered as a part of DIEP flap breast reconstruction given the reduction in the risk of abdominal donor site wounds. Though umbilectomy decreases the rate of wounds it can increase risk of seroma, thus other interventions such as progressive tension sutures may be explored to aid in reducing seroma and improving wound healing.