BACKGROUND: Abdominoplasty procedures are classically tailored to resect variable amounts of fat and skin and correct musculoaponeurotic laxity. Traditional abdominoplasty, lipoabdominoplasty, and mini-abdominoplasty continue to generate much discussion in the literature and at national meetings. However, abdominoplasty with ‘floating’ of the umbilicus has received little attention in the past 15 years. We believe this is the procedure of choice for middle age, postpartum women with a normal body mass index who desire a low scar. We report our experience and outline our modified technique.
METHODS: Retrospective review was performed from the authors’ practices to identify women who had abdominoplasty with umbilical stalk transection and repositioning, with or without liposuction. The inferior skin incision is marked 5 cm above the vulvar commissure with the skin on stretch and carried laterally in the inguinal crease. The superior incision is tentatively marked to give a scar to naval distance of at least 7cm. The final superior incision is not determined until the abdominal flap is undermined. To transect the umbilicus at the fascial level, one finger is placed externally into the umbilicus to ensure the transection proceeds below the skin base and above properitoneal fat or hernia contents. Abdominal undermining is performed to the rib margin and xiphoid. The umbilical fascial defect is closed with a 0-Ethibond figure-of-eight suture. The diastasis recti is closed with interrupted sutures from xiphoid to pubis. The new position of the umbilicus is determined by flexing the patient and performing skin excision. The umbilicus is may be repositioned 2-6 cm lower with a 0-Ethibond suture to the fascia.
RESULTS: Sixty patients age 34-56 had abdominoplasty with ‘floating’ of the umbilicus (Figure 1). Typical characteristics were mild skin and fat excess in the supraumbilical and infraumbilical regions, laxity of the overall musculoaponeurotic layer and diastasis recti, a normal BMI, and a relatively long distance between the umbilicus and the vulvar commissure. The skin excess was not enough to allow traditional abdominoplasty or lipoabdominoplasty without leaving the transverse scar too high on the abdominal wall or without requiring a vertical scar to close the original umbilical opening. The excess skin and musculoaponeurotic laxity was greater than could be corrected by a mini-abdominoplasty, with or without liposuction. No umbilical or incisional necrosis occurred in any patient with or without concomitant liposuction.
CONCLUSIONS: Abdominoplasty with inferior ‘floating’ of the umbilicus delivers a low horizontal scar without a vertical extension. The diastasis recti is corrected. The umbilicus can be positioned 2-6 cm lower on the abdominal wall with good aesthetic results. This technique should be in the plastic surgeon’s armamentarium for patients who do not have enough skin laxity for a traditional abdominoplasty without leaving a scar too high on the abdominal wall.