Umbilical Necrosis Following Bilateral Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction with Concomitant Risk-reducing Salpingo-oophorectomy in Hereditary Breast and Ovarian Cancer: A Case Report.

Risk-reducing mastectomy and risk-reducing salpingo-oophorectomy (RRSO) for patients with hereditary breast and ovarian cancer with a BRCA gene mutation can be performed with simultaneous breast reconstruction. In this report, we present a rare case of umbilical necrosis in bilateral deep inferior epigastric artery perforator flap breast reconstruction with concomitant risk-reducing mastectomy and RRSO. Both deep inferior epigastric artery flaps were elevated based on the perforators cranial to the umbilicus, which may have completely ceased the blood supply from the deep inferior epigastric arteries and caused umbilical necrosis. The supra-umbilical port was used for RRSO, which may have caused damage to the ligamentum teres hepatis, located cranial to the umbilicus. In the preoperative enhanced computed tomography, the ligamentum teres appeared to be a vein. Damage to the ligamentum teres through the supra-umbilical port might have caused umbilical necrosis due to venous congestion. Perforators and port positions might have contributed to the umbilical necrosis.