The balance of the abdomen has an intimacy relationship with the umbilicus anatomy. In this investigation, we proposed an “S”- shaped design aperture in the abdominal flap to transpose the umbilicus stalk. This strategy adds the advantage of a small, vertically orientated umbilicus with a sinuous scar, factors  that contributes navel appearance and patient satisfaction¹.        

PATIENTS AND METHODS

Initially, the abdomen is lipoaspirated on the zones SA1 to SA4².  The adipocutaneous abdominal flap is elevated from the pubic line to the xiphoid apendicis with a conservative undermining preserving the perfurators ^3,4 .The rectus muscle distasis  is corrected with 2-0 separated unabsorbed  sutures⁵. The umbilicus stalk is partially buried in the midline, lightly cranial than the initial position. The abdominal cutaneous flap is hold with quilting suture to the midline aponeurosis from the xiphoid apendicis closed to the umbilicus⁶.With the patient in 30o.dorso-flexion the inferior part of the flap is pulled preliminarly to the pubic border with moderate tension. Then, the umbilicus exit is projected over the midline on the cutaneous abdominal wall. Inside an elliptical figure cranially orientated, the umbilical aperture is incised following the “S” shape through the cutaneous tissue, which is partially thinned radially. The umbilicus stalk is pulled trough the “S” shaped access to the flap on the superior and inferior poles with absorbable 3-0 and separated 5-0 monofilamet stitches(Fig 1 and 2).

RESULTS

The “S”-shape strategy to repositioning the umbilicus were indicated in 320 abdominoplasties over the past 6 years. A vertical orientated navel, with hiding scar that enhancing the balance of the abdomen was obtained in the majority of the patients with minimal complications. The main complications were stenosis( 8 patients, 2.5%) and suture dehiscence of the umbilicus skin at the superior closure(6 patients, 1.9%). Revision were necessary in only 8 cases (2.5%)(Fig. 3)

DISCUSSION

The unique study concerning the umbilicus anatomy in the literature,scored the vertical and T- orientated umbilicus as the more attractive⁷. So, we elect the “S”- shape abdominal flap aperture, because the normal traction works favorably to a vertical more than a transversal design. In fact, many patients can be satisfied with the oval or inverted- U, V- umbilicoplasty shape after abdominoplasty⁸ or triangular flaps⁹. But these strategies can became less attractive along the time, because the supra-umbilical cutaneous laxidity enhances the horizontal vector predominance, contributing to a hiding navel. In our data 8 patients (0.4%) presented cicatricial stenosis. The revision were easily performed   once the S-shape preserves tissue, different of techniques that removes skin at the abdominal wall. In long-term follow-up it reflects the bright and shadow balance avoiding the complete exposure of the umbilicus scar, giving an optical illusion to the observer¹² (Fig.4).

CONCLUSION

The S-shaped aperture on the abdominal flap to transpose the umbilicus preserves tissue, contributes to a vertical orientated anatomic navel with a sinuous inner scar, adding grace and balance to the abdomen.  

FIGURES

Fig1.. (Above, left) The “S”- shaped planned incision inside an elliptical drawing representing the buried umbilicus contourn. (Right) The skin is incised through the subcutaneous in a “S”- fashion. (Below, left) Aspect of the umbilicus at the end of the surgery. (Right) Six month post-operative close view.         

Fig 2. Appearance of the umbilicus in the abdominal context in a black skin patient 6 month after abdominoplasty

Fig. 3..  Oblique view of the umbilicus, before and after, showing vertical orientated navel and conspicuous hiding scar. 

Fig.4 . The S-shaped umbilicus contributing to the rejuvenation of the abdomen.

REFERENCES

1. Malic C. C. Patient satisfaction with two different methods of umbilicoplasty. Plast. Reconstr. Surg. 119: 357, 2007.

2. Matarasso A . Lipossuction as an adjuvant to a full abdominoplasty. Plast. Reconstr. Surg. 95:829,1995

3. Taylor, G.I. Palmer J.H. The vascular territories(angiossomes) of the body: experimental study and clinical applications. Br. J. Plast. Surg. Mar 1987;40(2):113-41.

4. Saldanha, O. R., Pinto, E.B. d. S., Matos, W.N., Lucon, R.L., Magalhães,F., and Bello,.É.M.L.Lipoabdominoplasty without undermining.Aesthetic Surg.J. 21:518,2001

5. Nahas, F.X. An aesthetic classification of the abdomen based on the myoaponeurotic layer. 108: 1787,2001.