Introduction: The umbilicus has an important role in the natural and aesthetic appearance of the abdomen as it is the only “natural scar” present after birth and it creates perfect harmony within the body. The appearance of the umbilicus changes through aging and is affected by some pathology. In surgery, it is the target for many considerations of abdominoplasty techniques.
Pre-operative: Anesthesiologist evaluation and lab tests according to the AHA (American Heart Association) guidelines are performed. Markings are crucial to achieve optimal results as several locations have been described, but only some of them are acceptable. We describe our experience and best approach using the “Ideal Umbilicus Zone” as the area delimited over the midline (from the xyphoid process to the pubis), between the midpoint and the joint of the two upper thirds with the lower third.
Surgical technique: Umbilicoplasty follows after the lipoabdominoplasty procedure, usually by 2 weeks. Delaying the procedure has allowed us to diminish flap suffering and avoid some other complications. A cross-shaped incision is made after marking the ideal umbilicus location and flaps are sutured to the abdominal wall.
Post-operative: The wound is covered with gauze embedded with topical antibiotic (nitrofurazone) for 1 week and then replaced by a spherical splint or marble for 2 weeks. Loose garments and a foam vest are used from 4 to 6 weeks after the lipoabdominoplasty. After the umbilicoplasty, the garment is used for an extra 2–4 weeks.
Conclusion: Many techniques have been described for umbilicoplasty. However, most publications are not conclusive. X-shaped umbilicoplasty describes a new way to remake the belly button after full lipoabdominoplasty, but also after tumor resections, hernia reconstructions, or any other procedure involving umbilical deformities. Delaying the procedure results in fewer complications and better outcomes but it has to be carefully explained to the patient before the procedure.
Umbilicus Lipoabdominoplasty Abdominoplasty Neo-umbilicoplasty Tummy tuck Liposculpture High definition liposuction
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