BACKGROUND: The umbilicus is often not a midline structure. Centralization of the umbilicus during an abdominoplasty is routinely performed at the level of the skin; however, this is associated with a high rate of postoperative reversion. The authors propose using an eccentric fascial plication centered on the true midline to maintain postoperative centralization of the umbilicus in addition to correction at the skin level. METHODS: A retrospective study was conducted of all patients between 2015 and 2019 who underwent abdominoplasty with either skin only (concentric plication) or fascial (eccentric plication) umbilical centralization. The Fisher exact test and t test were used to compare the two groups and assess differences in rates of umbilical reversion. RESULTS: A total of 71 patients were included in the study; the majority of patients were women [ n = 69 (97%)] and White [ n = 50 (70%)]. There were 28 (39%) patients who underwent concentric plication, and 43 (61%) had eccentric plication. Mean body mass index in the concentric and eccentric groups was 32 kg/m 2 and 28.5 kg/m 2 , respectively. Average follow-up was 51.6 months for concentric plication and 27.8 months for eccentric plication. Of those who received concentric plication, 10 patients (36%) had their umbilicus revert to the preoperative position; none in the eccentric plication group reverted ( P < 0.0001). CONCLUSIONS: Midline placement of the umbilicus during an abdominoplasty is important in providing symmetry to optimize aesthetics. Eccentric fascial plication maintains the centralization of the umbilicus when compared with concentric fascial plication with skin-only centralization. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
References
Rohrich RJ, Sorokin ES, Brown SA, Gibby DL. Is the umbilicus truly midline? Clinical and medicolegal implications. Plast Reconstr Surg. 2003;112:259–263; discussion 264–265.
da Silva JV, de Sousa FRS. Improvement on the neo-umbilicoplasty technique and review of the literature. Aesthetic Plast Surg. 2017;41:600–607.
Joseph WJ, Sinno S, Brownstone ND, Mirrer J, Thanik VD. Creating the perfect umbilicus: a systematic review of recent literature. Aesthetic Plast Surg. 2016;40:372–379.
Standring S. Gray’s Anatomy: The Anatomical Basis of Clinical Practice, 41st ed. New York: Elsevier; 2016.
Rubin JP. Body Contouring and Liposuction. Edinburgh: Elsevier Saunders; 2013.
Southwell-Keely JP, Berry MG. Umbilical reconstruction: a review of techniques. J Plast Reconstr Aesthet Surg. 2011;64:803–808.
Bruekers SE, van der Lei B, Tan TL, Luijendijk RW, Stevens HP. “Scarless” umbilicoplasty: a new umbilicoplasty technique and a review of the English language literature. Ann Plast Surg. 2009;63:15–20.
Niranjan NS, Staiano JJ. An anatomical method for re-siting the umbilicus. Plast Reconstr Surg. 2004;113:2194–2198.
Dubou R, Ousterhout DK. Placement of the umbilicus in an abdominoplasty. Plast Reconstr Surg. 1978;61:291–293.
American Society of Plastic Surgeons. 2018 Plastic Surgery Statistics Report. 2018. Available at: https://www.PlasticSurgery.org/documents/News/Statistics/2018/plastic-surgery-statistics-full-report-2018.pdf .
Patronella CK. Redefining abdominal anatomy: 10 key elements for restoring form in abdominoplasty. Aesthet Surg J. 2015;35:972–986.
Martinez-Teixido L, Serra-Mestre JM, Serra-Renom JM. A new technique for creating a neo-umbilicus in abdominoplasty. J Plast Reconstr Aesthet Surg. 2017;70:1760–1767.
Correia N, Jayyosi L, Chiriac S, et al. Morphometric analysis of the umbilicus according to age. Aesthet Surg J. 2018;38:627–634.
Naraynsingh V, Maharaj R, Dan D, Hariharan S. Strong linea alba: myth or reality?. Med Hypoth. 2012;78:291–292.
Korenkov M, Beckers A, Koebke J, Lefering R, Tiling T, Troidl H. Biomechanical and morphological types of the linea alba and its possible role in the pathogenesis of midline incisional hernia. Eur J Surg. 2001;167:909–914.
Mejia JD. Colombian clover umbilicoplasty: achieving a natural looking belly button. Aesthet Surg J. 2020;40:342–347.
Ngaage LM, Kokosis G, Kachniarz B, et al. A two-step technique for neo-umbilicoplasty in the abdominal reconstructive population. Plast Reconstr Surg Glob Open. 2019;7:e2341.
Kurt Yazar S, Serin M, Diyarbakirlioglu M, Sirvan SS, Irmak F, Yazar M. Comparison of aesthetic outcome with round and three-armed star flap umbilicoplasty. J Plast Surg Hand Surg. 2019;53:227–231.
Dogan T. Umbilicoplasty in abdominoplasty: a new approach. Ann Plast Surg. 2010;64:718–721.
Neaman KC, Armstrong SD, Baca ME, Albert M, Vander Woude DL, Renucci JD. Outcomes of traditional cosmetic abdominoplasty in a community setting: a retrospective analysis of 1008 patients. Plast Reconstr Surg. 2013;131:403e–410e.
Kachare S, Kapsalis C, Kachare M, et al. Earplug umbilicoplasty: a simple method to prevent umbilical stenosis in a tummy tuck. Eplasty. 2019;19:e12.
