Improvement on the Neo-umbilicoplasty Technique and Review of the Literature.
BACKGROUND
The umbilicus is an important component of body esthetics, and its absence or dysmorphia may give rise to psychological discomfort, making it a common concern in surgical planning. Many techniques of umbilicus reconstruction have been proposed, each with its own limitations in terms of esthetics, risk of stenosis or final positioning. Reconstruction techniques may involve skin grafting, cartilage, purse-string suture and flaps. One of the most promising approaches is scarless neo-umbilicoplasty.


OBJECTIVE
To improve the technique of neo-umbilicoplasty, creating a deeper and more natural-looking umbilicus, and propose a reoperation technique for shallow umbilici.


METHODS
The sample consisted of 108 patients aged 25-67 years submitted to abdominoplasty and scarless neo-umbilicoplasty under epidural anesthesia performed by the same surgeon and at the same hospital between July 2013 and October 2015.


RESULTS
Follow-up lasted from 6 to 24 months. The new umbilici were scarless.


CONCLUSIONS
Many different techniques may be used to reconstruct the umbilicus. The main purpose is to create an adequately localized structure with a natural, youthful appearance and minimal scarring. To do so, we used ten (rather than six) attachment stitches and mobilized the adipose tissue toward the center of the new umbilicus to achieve greater depth, even in lean patients. Techniques which involve suturing the umbilical stalk onto the incised skin of the abdominal flap tend to produce unesthetic results, such as visible scars and umbilical skin islands of varying size. Scarless neo-umbilicoplasty does not require suture removal and poses no risk of dehiscence, secretion or umbilical stenosis, as observed with other techniques.


CONCLUSIONS
The localization of the new umbilicus in the space between the rectus abdominis muscles, the use of ten rather than six stitches and the mobilization of the adipose tissue toward the periumbilical area constitute an improvement on the neo-umbilicoplasty technique. The resulting umbilici were scarless and very natural-looking.


METHODS
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Plastic Surgery at Stetic Class Clinic, Institute Dr. José Frota and General Hospital Dr. César Cals, Rua Barão de Aracati, 1304 - Aldeota, Fortaleza, Ceará, CEP: 60.115-081, Brazil. valderijr@hotmail.com.
Valderi Vieira
VV
da Silva Júnior
Academic of Medicine of University of Fortaleza, Fortaleza, Ceará, Brazil.
Francis Régis Soares
FRS
de Sousa
D061645:Abdominoplasty / Q000379:methods*; D000328:Adult; D000368:Aged; D002921:Cicatrix / Q000517:prevention & control; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D017568:Rectus Abdominis / Q000601:surgery; D012494:Sampling Studies; D013524:Surgical Flaps / Q000637:transplantation*; D013536:Suture Techniques; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology
Abdominoplasty; Scarless technique; Umbilicoplasty; Umbilicus reconstruction