title: Creating the Perfect Umbilicus: A Systematic Review of Recent Literature.
abstract: BACKGROUND
  The aim of this study was to perform an updated systematic review of the literature over the last 10 years, analyzing and comparing the many published techniques with the hope of providing plastic surgeons with a new standard in creating the perfect umbilicus in the setting of both abdominoplasty and abdominally based free-flap breast reconstruction.
  
  
  METHODS
  An initial search using the PubMed online database with the keyword "umbilicoplasty" was performed. These results were filtered to only include articles published within the last 10 years. The remaining articles were thoroughly reviewed by the authors and only those pertaining to techniques for umbilicoplasty in the setting of abdominoplasty and abdominally based free flap were included.
  
  
  RESULTS
  Of the 10 unique techniques yielded by our search, 9/10 (90 %) initially incised the native umbilicus with a round, oval, or vertical ellipse pattern. Of the 9 techniques that initially perform a round incision, 4 of them (44.4 %) later modify the round umbilicus with either an inferior or superior excision to create either a "U"- or "inverted U"-shaped umbilicus. In terms of the shape of the incision made in the abdominal flap for umbilical reinsertion, the most common were either a round incision or an inverted "V" or "U," both of which accounted for 4/10 (40 %) and 3/10 (30 %), respectively. Almost all of the studies (8/10; 80 %) describe "defatting" or trimming of the subcutaneous adipose tissue around the incision to create a periumbilical concavity following inset of the umbilicus. 4/10 (40 %) of the techniques describe suturing the dermis of the umbilical skin to rectus fascia. Furthermore, 3/10 (30 %) advise that stalk plication is a necessary step to their technique. 7/9 techniques (77.8 %) preferred nondissolvable sutures for skin closure, with nylon being the most common suture material used. Only 2/9 (22.2 %) used dissolvable sutures.
  
  
  CONCLUSIONS
  Although future studies are necessary, it is our hope that this systematic review better elucidates the techniques and provides some guidance to both aesthetic and reconstructive plastic surgeons in the pursuit of creating the perfect umbilicus following abdominoplasty and TRAM/DIEP breast reconstruction.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Institute for Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, 10016, USA.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Joseph
authors.affiliation: Institute for Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, 10016, USA.
authors.forename: Sammy
authors.initials: S
authors.lastname: Sinno
authors.affiliation: Institute for Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, 10016, USA. brownsnd@rwjms.rutgers.edu.
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Brownstone
authors.affiliation: Institute for Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, 10016, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Mirrer
authors.affiliation: Institute for Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, 10016, USA.|NYU Plastic Surgery, 305 E 33rd St, New York, NY, 10016, USA.
authors.forename: Vishal D
authors.initials: VD
authors.lastname: Thanik
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D061645:Abdominoplasty / Q000379:methods*; D000328:Adult; D002398:Catgut; D002921:Cicatrix / Q000517:prevention & control; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D006801:Humans; D012189:Retrospective Studies; D013536:Suture Techniques; D013537:Sutures; D014472:Umbilicus / Q000601:surgery*
keywords: Abdominoplasty; DIEP; TRAM; Umbilicoplasty; Umbilicus