A Versatile Technique for Repositioning of the Umbilicus in Abdominoplasty

Abstract

Sir: Umbilical repositioning is a main step during abdominoplasty. The surgeon aims for minimal visible scars and a natural-looking result.1 Several techniques have been described, but none of them completely satisfy the aesthetic targets in all patients. Evidence of scar or retraction with umbilical stenosis may occur.2 The use of Y or double-Y cutaneous incisions has improved aesthetic results.3,4 We introduce a versatile technique for umbilicoplasty: an elliptical vertical incision of the umbilical skin and a double-opposing Y incision on the abdominal flap, to create a stable, natural-looking umbilicus. A prospective, open-label study was performed. Forty patients underwent abdominoplasty using the present technique for umbilicus repositioning. Patient age ranged between 24 and 63 years (36 women and four men). Body mass index ranged from 26 to 47 kg/m2 (mean, 33 kg/m2). Patient satisfaction and postoperative results were evaluated over a 12-month follow-up period. A modified 5-ml syringe was used to assess the depth and volume of the umbilical stalk. Variations in depth between 1 and 12 months were statistically compared using the Wilcoxon test. The umbilical skin is sharply incised vertically. The umbilical pedicle blood supply is preserved. The umbilical dermis is attached to the abdominal rectus fascia in four cardinal points with polyglecaprone 25 4–0 suture. In patients with a thin habitus, it is important to plicate the periumbilical fascia sufficiently to create an inverted umbilicus. The elliptical umbilical island is tightened against the tensed abdominal fascia without distortion. The site of umbilicus repositioning is determined by its projection on the abdominal flap. A small, double-opposing Y cutaneous incision is made in this point. The vertical size must be approximately the same as that of the original umbilicus. The angle and size of the four lateral incisions can be modified according to the width we want to obtain. Defatting is performed through the double-opposing Y incision. The umbilical skin is sutured to the surrounding abdominal skin with 4–0 nylon sutures. Four of these sutures are left longer and tied over a paraffin gauze patch to ensure deep umbilicus positioning. In all patients, an umbilicus with adequate depression was created. In one case, de-epithelization of the umbilical skin occurred and healed spontaneously in 2 weeks. After 12 months, no significant changes in shape, dimension, and appearance were observed. All patients were pleased with the final result. No cicatricial umbilical stenosis occurred, and no statistical significance was found comparing mean depth variations between 1 and 12 months (10.67 ± 1.34 ml and 10.4 ± 1.19, respectively; p = 0.0543). This technique gives a natural depth appearance, ensures optimal position, pulls scars deeply, avoids visible scarring, and allows achievement of different shapes according to the patient’s habitus (Figs. 1 and 2). Any umbilical size, in either obese or thin patients, can be created with this method. The double-opposing Y incision reinforces the vertical shape, creates natural umbilical dimpling, and prevents stenosis with stable results. This technique is easy to learn and simple to perform, effectively hides scars, and gives a youthful appearance to the umbilicus.Fig. 1.: Preoperative view of the umbilicus.Fig. 2.: Twelve-month postoperative view.Marco Mazzocchi, M.D., Ph.D. Luca A. Dessy, M.D. Andrea Figus, M.D. Department of Plastic Surgery University “La Sapienza” Rome, Italy DISCLOSURE The authors did not receive any financial support for this study, nor were they in any way commercially involved with any company.