Umbilicus and Scar Positioning During Abdominoplasty: Main Determinants of Results
Results in lipoabdominoplasty are becoming more satisfactory every time; however, there are still difficulties with the umbilicus and positioning of the transverse abdominal scar, general abdominal appearance and vascular safety The appearance and location of the lower transverse scar and the new navel, are the main determining factors in the final results of the surgery.
A review of the medical literature in English and Spanish was made regarding embryology, anatomy, semiology, and clinical applications, describing details of the proper technique and location of the scar and umbilicus, in order to obtain satisfactory and consistent results.
The author describes his own experiences, emphasizing that the position of the navel and the transverse incision should not be left to chance and must be manipulated by the surgeon following the basic principles of human proportionality.
The experience and utility of transverse plication abdominoplasty without flap elevation in the epigastrium and neo-umbilicoplasty (TULUA) is described. It has been used since 2005 in search of better scar and umbilicus positioning, with the additional advantages of vascular preservation, less tension during surgical wound closure, and less residual dead space.
Being free to select the new umbilical position, the scar of the new umbilicus is not very visible and the results are consistently good. This technique also allows for the safe repair of umbilical hernias without having the concern of necrosis of the umbilical stalk. The combination of a low scar placement, which is facilitated by the downward traction of the transverse plication, and a properly placed navel, ensures a harmonious result for each abdominoplasty.
It is estimated that the distance V (veneris) from the anterior vulvar commissure to the abdominoplasty scar should be approximately between 5 and 7 cm; and the distance H (hypogastrium) from the scar to the navel should be approximately between 9 and 14 cm. This achieves an H/V ratio similar to the ideal ratio of 1.618. This coefficient has been found to be of clinical use in the intra-operative decision-making process.
Excluding some cases, it is recommended to amputate the original navel and to create a new one by neo-umbilicoplasty using a skin graft, combined with the series of modifications described in the TULUA abdominoplasty.
Intra-operatively, the best placement of the scar can be decided using resources such as transverse plication, progressive tension sutures, superficial fascia closure with sutures, and anchorage to the inferior fixed points. A small vertical component in the midline of an anchor-shaped transverse scar is preferred, rather than an excessive elevation of the hairy skin of the mons veneris.
Adequate surgical planning, measurement during surgery, and careful surgical placement of the scar and umbilicus are recommended, therefore the appropriate position of these two determinants of the result is not left to chance.
KeywordsAbdominoplasty/methods/adverse effects Lipectomy/adverse effects Abdominal wall/anatomy and histology/blood supply/surgery Umbilicus/abnormalities/anatomy and histology/blood supply/embryology/surgery Necrosis/surgery/complications/prevention and control Scar/surgery/prevention and control
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