An Algorithmic Approach to Umbilical Inset during DIEP Flap Reconstruction

An aesthetically-pleasing umbilicus is a critical component to the overall cosmesis and resultant patient satisfaction after DIEP flap breast reconstruction. Patients undergoing this procedure are frequently at a higher risk of umbilical complications and poor aesthetic appearance of the neo-umbilicus, due to patient variables in body habitus, comorbidities, and technical aspects of the procedure, as compared to those undergoing cosmetic abdominoplasty. In order to minimize these potential problems and maximize the overall aesthetic appearance of the abdomen, we propose an algorithmic approach to umbilical inset after DIEP flap harvest that takes into account several critical factors: the thickness of the subcutaneous tissue of a patient’s abdominal flap, the length of the umbilical stalk, and the depth of the umbilical bowl. We believe that this simple algorithmic approach is a useful tool that will assist surgeons in minimizing umbilical complications and delivering a superior cosmetic appearance to the abdominal donor site in DIEP flap reconstruction.