title: The Divine Proportion "Ace of Spades" Umbilicoplasty: A New Method of Navel Positioning and Plasty in Abdominoplasty.
abstract: BACKGROUND
  Achievement of a well-balanced positioned navel along the longitudinal axis with a pleasing shape and hidden scarring will have a tremendous impact on the overall cosmetic outcome of an abdominoplasty. In this era of navel display, piercing, and tattooing, an increasing attention is paid by people toward navel shape and position. However, in plastic surgery, there is no standardization regarding navel repositioning and plasty during abdominoplasty. The aim of this article is to describe the clinical translation of our observational study on navel surface anatomy by reporting our experience with a new umbilicoplasty technique.
  
  
  METHODS
  Between July 2013 and March 2014, 23 consecutive patients underwent elective deep inferior epigastric perforator free flap breast reconstruction. Patients' mean age was 45.5 years (range, 36-68 years). Ten patients were normal weight, 11 were overweight, and 2 were class-1 obese. All 23 patients underwent the divine proportion ace of spade umbilicoplasty.
  
  
  RESULTS
  Pleasant looking, depressed, and oval navels with superior hooding were successfully achieved. No infection or necrosis of the navel skin or abdominal skin flaps was experienced. Additionally, no scar constriction, navel distortion, or stenosis occurred. Postoperative results were graded as excellent in 8 cases (36%), very good in 12 (55%), and good in the 2 cases (9%) with mildly hypertrophic scars. Patient satisfaction was high to very high.
  
  
  CONCLUSIONS
  A Fibonacci caliper might aid in the proper positioning of the umbilicus on the abdominal wall avoiding an undesirable high- or low-riding navel. The "ace of spades" umbilicoplasty restores a natural-looking depressed navel with an oval shape and superior hooding.
authors.affiliation: From the Department of Plastic and Reconstructive Surgery, Università Cattolica del "Sacro Cuore", University Hospital "A. Gemelli", Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Visconti
authors.forename: Marzia
authors.initials: M
authors.lastname: Salgarello
mesh_terms: D061645:Abdominoplasty / Q000379:methods*; D000328:Adult; D000368:Aged; D019074:Epigastric Arteries / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation*; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D014472:Umbilicus / Q000601:surgery*