Following an abdominoplasty the umbilicus is repositioned and inset into a new position. When healed it should have a natural appearance and in order to get this outcome it is necessary to understand what is ‘normal’.
Several different morphological appearances of the human umbilicus have been described [1,2]. In essence the periumbilical and umbilical area may be described in an idealised form as seen in Figure 1.
Figure 1: Idealised Umbilicus:
1. Supra-periumbilical depression,
2. infra umbilical depression leading into central umbilicus,
3. Superior Ubilical hood, 4&5 Lateral ridges (Medial aspect of rectus muscle)
In this approach the umbilical area is initially incised as a triangle during the abdominoplasty skin and subcutaneous excision (Figure 2).
Figure 2: Initial umbilicus incision on abdomen down to rectus sheath.
The abdominoplasty is performed and the skin flap inset as planned. On the planned site for the new umbilicus a 2.5 x 2cm oval is marked. Inside the oval an elongated curved X is marked with the superior limbs longer then the lower (Figure 3).
Figure 3: Marking on skin – oval and X.
The ‘X’ is incised and the X flaps, with an area 2cm peripheral to the oval, are defatted to produce the periumbilical depression as planned (Figure 1); the umbilical stalk is delivered through the opening. The depth of the umbilicus is trimmed so that the patient is able to clean inside this area after healing, the depth is planned as the same length of tube as the subcutaneous fat of the abdominoplasty fat thickness. The edges of the tube are then excised in a reverse pattern to the ‘X’. The skin flaps on the abdominal flaps are then inset with 5-0 Vicryl sutures (Figure 4).
Figure 4: Umbilical stalk shortened and inset to abdominal X.
The area is then dressed with an absorbent dressing and allowed to heal (Figure 5).
Figure 5: Healed X neo-umbilicoplasty.
This X neo-umbilicoplasty produces a more natural looking appearance with the features as planned. The asymmetric ‘X’ incision produces a superior ‘hood’ effect and the lower inset produces the infra-umbilical depression and the inferior depression. The periumbilical defatting produces the depression around the centre of the umbilicus. The X inset produces a ‘broken line’ scar and reduces the incidence of a circular contraction of the scar. All these features produce a natural appearance with the X neo-umbilicoplasty.
References
1. Cavale N, Butler PEM. The Ideal Female Umbilicus? Plastic and Reconstructive Surgery 2008;121(5):356e-357e.
2. Craig SB, Faller MS, Puckett CL. In search of the ideal female umbilicus. Plastic and Reconstructive Surgery 2000;105(1):389-92.
Declaration of competing interests: None declared.
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