'Scarless reverse umbilicoplasty': A new technique of umbilical transposition in abdominoplasty

Refining Abdominoplasty: A Novel Technique for Umbilical Reconstruction

BACKGROUND

The umbilicus holds significant aesthetic and symbolic importance in abdominal contouring. Its position, shape, and overall appearance are pivotal in determining the success and patient satisfaction after abdominoplasty, although the best way to archive it is discussed. We present our technique with our statistics and complication rate.

METHODS

We conducted a literature review using PubMed and a retrospective review of patients between March 2023 and October 2023. Our technique involves specific steps to ensure a natural and aesthetically pleasing umbilicus, with minimal complications.

RESULTS

Of 49 patients, 4% experienced umbilical complications (2% partial dehiscence of umbilical knot, 2% necrosis of the navel), and 96% had no complications. Our technique showed a similar complication rate as the studies evaluated.

CONCLUSION

Our technique for umbilical reconstruction provides superior aesthetic outcomes and minimized complications, making it a viable option in abdominoplasty procedures.

BULLET POINT LIST

Novel Technique: The study introduces a new technique for umbilical reconstruction in abdominoplasty, emphasizing superior aesthetic outcomes and minimal complications. Low Complication Rate: Of the 49 patients studied, only 4% experienced complications, demonstrating the safety and efficacy of the technique. Patient Satisfaction: High patient satisfaction was noted, with feedback highlighting the natural and aesthetically pleasing appearance of the reconstructed umbilicus. Comprehensive Review: The research includes a thorough literature review and a retrospective analysis of patients, providing a well-rounded perspective on the technique's.

LEVEL OF EVIDENCE IV

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Total umbilical reconstruction using a tri-radiate incision technique

BACKGROUND

Neo-umbilicus aesthetics, often previously ignored or considered an afterthought, is now a major concern in abdominal surgical planning for abdominoplasty in morbid obesity and ventral hernia repairs. Umbilical loss or deformation is immediately recognised owing to its central position causing psychological discomfort, stress and low self-esteem in patients. Several umbilical surgical techniques are described, but there is no universally accepted "standard" technique for umbilical reconstruction. Our purpose was to describe a new method, the tri-radiate incision (TRI) which leads to the creation of an aesthetically pleasing navel, significantly improving the patient's satisfaction and surgeon's cosmetic standards.

METHODS AND MATERIALS

This study consisted of 21 consecutive cases of umbilical reconstruction of obese (18) and non-obese (3) patients during abdominoplasty (10) or ventral hernia repair (11) as the main indicators and patient satisfaction was rated post-operatively.

RESULTS

No major post-operative complications such as flap necrosis, umbilical stenosis, flattening or misplacement, cicatricial hypertrophic scarring, infection or haematoma, as recorded in various techniques requiring revision surgeries, were encountered. Serosanguineous discharge observed during the first week was very common. Patient satisfaction with the umbilicus was rated 10/10 by 17 patients and 9/10 by 4 patients from the obese and non-obese categories.

CONCLUSION

The minimally scarring TRI neo-umbilicus technique offers a new option regardless of age, gender or body mass index in creating a neo-umbilicus that is safe, reliable and reproducible using a single-staged procedure. It achieves all the permanently desired aesthetic standards, with relatively little or no post-operative complications but high patient satisfaction in abdominoplasty and hernia repair.

Determination of Appropriate Umbilicus Position during Abdominoplasty in Male Patients

Background

Abdominoplasty techniques are well documented. The ideal position of the umbilicus has, however, received limited attention. Unfortunately, umbilicus position is not universally agreed upon in male cosmetic abdominoplasty. This study was conducted to determine the ideal umbilicus anthropometric measurements in young men, and the relationships between umbilical position and anterior trunk and torso reference points that may be applicable to intraoperative positioning. It is aimed also at investigating whether umbilicus position would be more accurately determined by considering nipple position instead of the abdominal crease, as recently proposed.

Methods

Several anthropometric measurements of various anterior abdominal and thoracic landmarks were conducted on 60 young and middle-aged male volunteers and 30 cadavers at São Paulo city. All statistical analysis was completed using Stata software.

Results

Of all the measured reference points, a much stronger correlation (0.513) was demonstrated between umbilicus-anterior axillary fold (U-AX) and inter-nipple (N-N) distances with a constant golden number ratio relationship (N-N = U-AX × 0.618) compared with the weak correlation of 0.034 between umbilicus-xiphisternum and umbilicus-abdominal crease. In 75% of volunteers, the calculated U-AX was within ±3 cm of actual measurement, and in 33.33% within ±1 cm.

Conclusions

U-AX = 1.618 × N-N equation is more predictive of adequate umbilicus repositioning during abdominoplasty in male patients. Chest and abdomen of men are a single aesthetic unit. Proper positioning of the nipples and umbilicus, as well as harmonious abdominal and torso proportions are critical for an optimal final aesthetic outcome.

New Method for Umbilicoplasty with Bilateral Square Flap and Caudal Deep Inferior Epigastric Artery Perforator Flap

BACKGROUND

The navel is an important cosmetic feature of the abdomen. A vertically long navel with a deep caudal side has recently been preferred by patients. Currently, there is no plastic surgery technique for complete umbilical repositioning or plasty after umbilical keloid resection. This study aimed to examine the effect of a new umbilicoplasty by combining a bilateral square flap with a triangular flap that utilizes the excess caudal skin nourished by the deep inferior epigastric artery perforator.

METHODS

A total of 23 patients underwent umbilical keloid resection and new umbilicoplasty between April 2018 and March 2020. The mean patient age was 48.2 (range: 36-68) years, and mean body mass index was 23.1 (range: 18.5-33.4). Satisfaction with umbilical morphology was evaluated on a 5-point scale through interviews.

RESULTS

The surgery resulted in forming a vertically elongated deep caudal umbilical fossa. All patients were satisfied with their umbilical morphology (mean score, 4.6). In one case involving a woman who underwent breast reconstruction with a deep inferior epigastric artery perforator flap, superficial necrosis of the triangular flap was observed. However, no other complications were observed.

CONCLUSIONS

Creating a flap with stable blood circulation using the tissue originally excised during umbilical surgery allowed for the reproduction of a desirable umbilical morphology with adequate verticality and caudal depth.

Non-scarring Minimal Incision Neo-omphaloplasty in Abdominoplasty: The Alvarez Technique. A New Proposal

Background:

Abdominoplasties are increasingly requested aesthetic, reconstructive surgical procedures that, in most cases, have shown the disadvantage of leaving an often-notorious periumbilical scar due to hypertrophy, keloid, or because it simply remains very visible over time, after surgery. The Alvarez technique (or nonscarring minimal-incision neo-omphaloplasty) is a completely new, unprecedented technique because it does not leave visible scars. This technique requires the generation of four small flaps and a purse-string suture system interacting with the aponeurosis of the rectus abdominis muscles, as well as the modification of the vertical abdominal plication, and management of the subcutaneous cellular tissue in the new umbilicus area, which, if executed correctly, provide adequate aesthetic results.

Methods:

A multicentric case-series scientific study is presented with a total of 94 patients who underwent classical abdominoplasties and neo-omphaloplasties with the aforementioned technique from August 2018 to December 2020. Pre-surgical and postoperative photographic files were collected.

Results:

Of the 94 patients, there were eight (8.5%) cases of seroma, which are not attributable to neo-omphaloplasty but inherent to the use of drains. There were five (5.3%) cases of umbilical dehiscence. In total, 89.2% (84 patients) showed a very high degree of long-term satisfaction, and 10.6% (10 patients) had a medium level of long-term satisfaction.

Conclusions:

The Alvarez technique provides good aesthetic results that are well accepted among patients and surgeons, in the short and long term. It is useful for those patients who wish to undergo an abdominoplasty but cannot stand a scar in the umbilical region.

[Shape and aesthetic outcome evaluation of transposed umbilicus according to four surgical procedures]

INTRODUCTION

In abdominal plastic surgery, umbilicus is frequently transposed, generating scars and shapes variating with the techniques used. Various umbilical transposition techniques have been described, all of them attempt to reproduce the "ideal" umbilicus. This study aimed to define the shape and the aesthetic results obtained with four different surgical procedures, in order to choose an "ideal" umbilical transposition technique.

PATIENTS AND METHODS

This retrospective study analyzed the characteristics of transposed umbilicus, in 50 patients who had undergone abdominal dermolipectomy for aesthetic reason, after a loss of weight or in breast reconstruction by Deep-Inferior-Epigastric-Perforator. Four surgical procedures were chosen, which differed by their counter-incision shape in the abdominal flap (Y, inverted Y, de-epidermized round with horizontal incision or U), and the deep points position of umbilical docking (along a horizontal or vertical axis). Shape and depth were evaluated by a panel of experts. The global assessment was based on a double evaluation, by the surgical jury and the patients themselves.

RESULTS

The counter-incision type determined the umbilicus shape: triangular for the Y (60%) or inverted-Y (41%), round for the U (52%) and vertical oval (67%) or round (32%) for the de-epidermized circle. The deep points position influenced the umbilicus axis. Regarding the appreciation, the de-epidermized circle had the best results for surgeons in a significant way, and for patients (respectively 72% and 100% satisfied), followed by the inverted-Y (57% and 92%) and Y techniques (55% and 89%) and at last the U (50 and 75%).

CONCLUSION

Horizontal counter incision in a de-epidermized round, with two anchoring points on a vertical axis, generates vertical oval or round shaped umbilicus, considered attractive in the literature, and giving the highest aesthetic satisfaction for both surgeons and patients.