Natural-Looking Umbilicus as an Important Part of Abdominoplasty (original) (raw)

Umbilical restoration in abdominoplasty A simple rectangular technique

Aesthetic Surgery Journal, 2003

Background: Many surgical procedures for reconstructing the umbilicus during dermolipectomy have been described. Objective: The authors present a simple technique for umbilicus restoration in abdominal dermolipectomy to improve the shape of the umbilicus and disguise the periumbilical scar. Methods: A skin incision was made to free the umbilicus from its original position. Two fixation points, at the 6-o'clock and 12-o'clock positions, 5 mm under the margin of the umbilicus, were employed to attach the umbilicus to the aponeurosis of the linea alba and the xiphoumbilical line, respectively. The index finger was inserted through the lower abdominal incision, after which the location of the umbilicus was palpated and marked on the abdominal skin 0.5 cm under the projected position of the neoumbilicus. A rectangle was drawn on the abdominal skin, marking the neoumbilical position. After skin incision around the neoumbilical position, subcutaneous fat was removed with scissors. Results: From February 1999 to June 2003, the procedure was performed in 142 patients, with good results and only minor complications. Conclusion: The rectangular technique for restoration of the umbilicus is a simple, successful, and safe procedure.

The Two-Dermal-Flap Umbilical Transposition: A Natural and Aesthetic Umbilicus after Abdominoplasty

Plastic and Reconstructive Surgery, 2007

Background: The aesthetic and natural appearance of the transposed umbilicus after abdominoplasty is a key factor to the overall result and satisfaction of patient and surgeon alike. In this article, the authors present a technique in umbilical transposition that creates a natural-appearing umbilicus. Methods: The skin in the neoumbilical position is deepithelialized and incised in the midline, thus creating two dermal flaps that are sutured down to the abdominal fascia, thereby creating a natural periumbilical concavity, inconspicuous scars, and a tension-free closure, resulting in a decreased chance for cicatricial umbilical scarring. Twenty patients underwent umbilical transposition during abdominoplasty with this technique between 2003 and 2005. Results: Both patient and surgeon satisfaction were very high, with three senior surgeons changing their surgical technique after being introduced to that described in this article. One complication culminated in partial skin dehiscence early in our experience when deep dermal sutures were not used for skin closure. Conclusion: The technique described is simple, safe, and easily learned, and results in a very satisfying aesthetic and natural-appearing umbilicus in patients after abdominoplasty.

Long-Term Results of a Versatile Technique for Umbilicoplasty in Abdominoplasty

Aesthetic Plastic Surgery, 2011

Background Umbilical repositioning is a main step in performing abdominoplasty. The surgical aims are minimal visible scars and a natural-appearing result. Reported techniques do not completely satisfy the aesthetic targets for all types of patients. A previous study reported a versatile technique for umbilicoplasty based on an elliptical vertical incision of the umbilical skin and a double opposing ''Y'' incision on the abdominal flap to create a new umbilicus. This report describes the long-term results with this technique. Methods A total of 111 abdominoplasties were performed. Patient satisfaction and postoperative results were evaluated over a 5-year follow-up period. A modified 5-ml syringe was used to assess the depth and volume of the umbilical stalk. Depth value variations were statistically compared using the Wilcoxon test. Results For all the patients, a three-dimensional umbilicus with an adequate depression was created. In four cases, deepithelialization of the umbilical skin occurred. After 1 postoperative year, no significant changes in umbilical shape, dimension, depth, or appearance were observed. After 5 years, no significant changes in shape or appearance were observed. The cicatricial umbilical stenosis occurrence was 4.5%. A small significant decrease in umbilical depth was noted. Overall, the results remained satisfying at this writing. Conclusions The reported technique is easy to learn, simple to perform, and stable over time. It gives a natural depth appearance, ensures optimal position, pulls scars deeply, and allows achievement of different shapes according to the patient's habitus.

A New Umbilical Reconstruction Technique Used for 306 Consecutive Abdominoplasties

Aesthetic Plastic Surgery, 2012

Background The search for a natural-appearing umbilicus that does not compromise the aesthetic outcome of abdominoplasty began in the 1950s and coincides with the period that saw increasing exposure of the female body. Since then, umbilical transposition has been favored by most surgeons. Methods This report describes a new technique for umbilical reconstruction using a small X-shaped incision that creates four V-shaped flaps, which are sutured to the aponeurosis with absorbable sutures. This technique was used for 306 consecutive abdominoplasty patients, and a survey was performed to determine their level of satisfaction with the surgical outcome. Results A natural-appearing new umbilicus was created with no visible scars, a low complication rate (9 %), and a high level of patient satisfaction. Conclusions The described technique had a low complication rate and allowed the creation of a new umbilicus with a natural appearance in a rapid, safe, and simple manner.

Abdominoplasty: Technical refinement and analysis of 130 cases in 8 years' follow-up

Aesthetic Plastic Surgery, 1983

The author describes surgical details and improvements on his personal technique. He establishes a relationship between the method and the natural phenomenon that occurs on the umbilical region of the newborn child. The author suggests reimplanting the umbilicus 1 cm below its natural projection on the abdominal flap. He presents two new instruments, one to facilitate the incisions and the other to help the marking of the umbilical area. He describes 8 years" follow-up of 130 patients.

The Inverted-V Chevron Umbilicoplasty for Breast Reconstruction and Abdominoplasty

Aesthetic Surgery Journal, 2011

The umbilicus is unique in that it is a conspicuous scar, but one that is aesthetically essential. It is a reminder of our birth: the absence or deformation of an umbilical scar is as unsettling as it is inhuman. The navel is a vital aesthetic unit; deformities are immediately recognized due to its central position. Although repositioning of the umbilicus in abdominoplasty and abdominal wall donor-site closure (as with deep inferior epigastric perforator [DIEP] and transverse rectus abdominis myocutaneous [TRAM] flaps) is a minor component, it is a critical detail. Focus on aesthetic results can dramatically shift outcomes and patient satisfaction since an unnaturally scarred umbilicus may be the only visible scar revealing previous abdominoplasty. 1 Many techniques have been described for achieving aesthetic repositioning through horizontal incisions, 2 vertical incisions, 3,4 Scarpa's fascia, 5 deep suture lines, 6-8 single flaps, 9-11 multiple flaps, 12-14 de-epithelialized flaps, 15,16 dermabrasion, 1 and neoumbilical creation. 17-20 In designing an approach, malposition, scarring, cicatricial ring formation, and poor form should be avoided. The aesthetically-pleasing umbilicus in thin females tends to be small, shallow, and vertically-oriented in nature, with superior hooding and shadow, inferior retraction and slope, and positioning at the level of the anterior superior iliac crest (Figure 1). 4,21,22 An umbilicus is usually no wider than 1.5 to 2 cm or longer than 3 cm (Figure 2), 16,21 and its size is proportionally decreased in smaller and thinner patients. However, with age and weight gain, fat accumulation can cause a deepening and widening of the umbilicus. 11 With an appropriately performed umbilicoplasty, these consequences may be reversed. The senior surgeon's (MAL) method, the inverted-V chevron umbilicoplasty, satisfies the aesthetic concerns outlined above. The nuances of the technique support the restoration of a youthful umbilicus.

Comparison of aesthetic outcome with round and three-armed star flap umbilicoplasty

Journal of Plastic Surgery and Hand Surgery, 2019

Background: The umbilicus is an indicative aesthetic component of the abdomen. Many umbilicoplasty techniques have been defined and the most commonly used method is the round incision technique. In this paper, we present a new umbilicoplasty technique involving the use of a three-armed star flap and compare it with the round technique. Methods: Forty-eight female patients who underwent umbilicoplasty during abdominoplasty and free deep inferior epigastric perforator flap (DIEP) procedures between February 2011 and December 2016 were included in the study. Twenty patients had round umbilicoplasty, whereas in the remaining 28 patients the three armed star flap technique was used. Aesthetic outcomes of both techniques were evaluated by a questionnaire which was completed by the patients and two independent surgeons. Results: The mean follow-up period was 22 months. Hypertrophic scarring was seen in one patient with the three armed star flap technique and in two patients with the round technique and a cicatricial ring formation occurred in one patient with the round technique. The patient and surgeon questionnaire scores were significantly higher in the 3-armed star flap group. (p < .05) Conclusion: In this study, round umbilicoplasty technique has been compared with the three armed star flap technique. Patient satisfaction surveys and evaluation by two independent surgeons revealed better cosmetic results with the new technique. We believe that this new technique could be preferred over the round technique since it prevents stenosis, circular scar contraction and provides a natural contour between the umbilicus and abdomen.

New Concepts on Safer Abdominoplasty

Body Contouring and Sculpting, 2016

Abdominoplasty was one of the first techniques described in literatura, and in some of his writings, Hippocrates mentioned the resection of skin and the apron-like abdominal flaps. The first standardization of this procedure was carried out by H.A. Kelly, who was a gynecologist, in 1890, but the procedure gained some popularity when Pitanguy published his report in 1967. With the advent of liposuction, they tried to replace abdominoplasty; however, in many cases, they yielded unreliable results. It was in the year 2000, with the advent of the pull down abdominal flap technique proposed by Avelar and then spread by Saldanha, surgeons significantly increased the indications for abdominoplasty. This was reflected in international statistics since abdominoplasty climbed from the 15th place in the 1990s to the 4th place in 2012. According to some publications, traditional abdominoplasty generally includes extensive dissection of upper abdominal flap all the way to the costal margin with a consequent decrease of blood flow of 50-70%. We present a technique with no flap undermining, including inbloc resection of premarked área from the umbillicus scar to the suprapubic area, dissecting the tissue with an instrument called Iconoclast, thus preserving blood flow, after hydrodissection with tumescent solution, which varies if the patient is under general anesthesia or sedation. It has been shown that simultaneous liposuction of flap and flanks in the conventional abdominoplasty technique increases the risk of necrosis and seromas, so in many cases it is contraindicated. Therefore, our technique allows us to perform the liposuction of the upper abdominal flanks and waistline without running any risks. In this technique umbilicus scar its recreated with the use of skin graft. Unlike conventional abdominoplasty techniques, the presence of previous abdominal wall scars is not a limitation. In the case of smokers patients, risks are reduced by keeping the blood flow of the upper flap constant. We do not recommend this technique for very thin patients, with multiple pregnancies and regularly an important rectus muscles diastasis where we indicate the abdominal wall.vertical plicature.