Umbilical tailoring in abdominoplasty: a simple and consistent way of shortening a post-bariatric umbilicus

Background

One of the key aesthetic aspects of abdominoplasty is the appearance of the new umbilicus. In post-bariatric patients, the umbilicus appears hooded and heavy superiorly. In a cohort of these patients, a long stalk is identified intraoperatively. The technique is a simple, easily reproducible method of removing the surplus tissue in these patients and converts it to a more vertical orientation, as seen in slimmer individuals.

Technique

• Mark the 12 o’clock and 6 o’clock positions with a suture for orientation (Fig 1).

• Deliver the umbilicus through the neo-umbilical site, measure and mark the height required.

• Apply two skin hooks on either side of umbilical stalk, pull taught vertically.

• Incise the umbilical stalk horizontally at 3 o’clock and 9 o’clock (Fig 2).

• Circumferentially excise the excess to the desired height. Make allowance for the surrounding cushion of skin that will envelope the mamelon (central depression).

• Fix the tailored umbilicus to the deep abdominal fascia and skin with a half-buried mattress suture with nylon 5/0 at 3, 6, 9 and 12 o’clock. Pass the suture through the epidermal edge of the umbilicus, into abdominal fascia, through dermis of the abdominal skin and back through the umbilicus skin edge and tie the knot (Fig 3).

• Perform the remaining umbilical wound closure using the half-buried horizontal mattress stitch with nylon 5/0 (Fig 4).

• Remove all nylon sutures at 10 days.

Figure 1.

Tacking stitches at 12 o’clock and 6 o’clock, umbilical stalk measuring 9.5 cm

Figure 2.

Incisions made at 3 o’clock and 9 o’clock to the desired height with, excess circumferentially removed

Figure 3.

Neo-umbilical stalk measuring 4.5 cm

Figure 4.

The umbilical stalk fixed to the abdominal fascia and neighbouring abdominal skin at the neo-umbilical site with remaining skin closed, both with half-buried mattress sutures

Discussion

The main aesthetic components of a tailored umbilicus include the position, depth, shape and location of the scar.¹ The described technique is a simple method that reduces depth, centralises the umbilicus and adjusts the shape to create a youthful and more vertically oriented umbilicus without compromise to the blood supply, supporting immaculate wound healing.