House-roof Neoumbilicoplasty: Six-step Procedure for a Natural Navel.

The umbilicus is an important anatomical structure in the aesthetics of the human body because it plays a fundamental role in abdominal harmony. 1 – 3 It is considered a unique body scar tissue because it is the only one that remains after birth. Certain surgical procedures, including umbilical herniorrhaphy and laparotomies, require reconstruction of the umbilicus by neoumbilicoplasty as it is for abdominoplasty. 2 Inadequate location of the belly button as well as its absence may be disturbing for some patients due to the lack of body harmony in the abdominal region. 1 Umbilicoplasty and neoumbilicoplasty have gone through several modifications since the first description made by Vernon. 4 Techniques have addressed different issues and have focused on different approaches, including transposition of the original navel and the use of skin, cartilage grafts, and local flaps of different shapes. 5 – 7 To mention some of the most relevant techniques, Santanelli performed navel amputation and fixed the abdominal flap to the stump through a small incision. Then, the belly button would be created by second intention healing. 8 Amud reported a scarless technique with a high risk of flattening, 9 whereas Hoyos et al reported the shortcomings of prior techniques and compared two of their own (Fig. 1 ). The Hoyos technique included the revolutionary concept of the ideal location of the new umbilicus by analyzing gender-based anatomical features. 10 Some of the techniques we have described above are difficult to reproduce and may have higher complication rates. Therefore, our study aimed to describe an original technique for neoumbilicoplasty that follows six easy steps (Table 1 ). Indications for Neoumbilicoplasties Aesthetic umbilical zones by gender as described by Hoyos et al. For men, the ideal umbilicus position is set between the top of the distal third and its junction with the distal two-thirds of the span from the xyphoid to the pubis. In women, the optimal zone lies between the midpoint of this distance and the top of the distal third.

We reviewed records of both men and women who underwent lipoabdominoplasty from February 2021 to June 2023 at a single center in Bogota, Colombia, all performed by the primary author (L.C.). The procedure included lipoabdominoplasty as the initial stage, followed by deferred neoumbilicoplasty. The natural umbilical stump was resected and sutured with a figure-eight stitch to close the fascia. Patients who had additional procedures (such as breast augmentation/reduction, fat grafting, and liposculpture) were also included. Exclusion criteria were procedures unrelated to neoumbilicoplasty, like liposculpture alone, miniabdominoplasty, and navel transposition. A professional photographer documented the imaging records before surgery; during the operation; and at follow-ups at 7 days and 1, 3, 6, and 12 months. During the third to sixth month postoperative period, patients answered a satisfaction survey based on the Global Aesthetic Improvement Scale. With the patient in a standing position, the ideal location for neoumbilicoplasty is in the lower medial region of the middle third, approximately 2 cm above the iliac crest. A horizontal marking of 8 mm is made in addition to a marking of two lower lines of 1 cm in length, forming a 45-degree angle with the previous line in the form of a house roof (Fig. 1 ). Then, with the patient in the supine position, after the general anesthesia, the surgery is started by incising the lines of the preoperative marking to perform house-roof neoumbilicoplasty. [ See Video 1 (online) , which displays house-roof neoumbilicoplasty. Markings are done according to Hoyos umbilical zones by gender, while the technique has some variations. We perform a greater angulation at the top flaps to improve the elongated appearance of the umbilicus.] Dissection is done plane-by-plane deep down to the aponeurosis of the rectus abdominis. This results in one superior flap and one inferior flap. Inferior flap undermining and defatting are performed for 1 cm under maximum traction until a thickness of 8–10 mm is achieved. The apex is anchored to the fascia with a 0-0 Nylon simple interrupted suture. An additional anchoring suture is placed from the superior flap to the aponeurosis, 2 mm below the previous stitch. The superior flap is then undermined and defatted until a thickness of 5 mm is reached. Then, we close the inferior flap towards the superior flap borders with Monocryl 4-0 simple interrupted suture. Starting from distal to proximal (three or four stitches in total). Finally, a Gillies corner stitch is made from the superior flap to the inferior flap. This will result in a natural umbilical hood. Video 1 which displays house-roof neoumbilicoplasty. Markings are done according to Hoyos umbilical zones by gender, while the technique has some variations. We perform a greater angulation at the top flaps to improve the elongated appearance of the umbilicus. 1_5aquvmq7 Kaltura

We evaluated 90 consecutive cases: 88 women (98%) and two men (2%) (Fig. 2 ). The mean age was 37.7 years (range: 21–58). Pre- and postoperative mean body mass index (BMI) was 24.9 kg per m 2 and 24.2 kg per m 2 , respectively. Duration of surgery was on average 84 minutes; however, the range was too wide due to combined procedures that lengthened the procedure duration in selected cases (Table 2 ). Average follow-up was 8 months (range 3–16 months). No major complications were reported. Minor complications included dehiscence (6%), granuloma (5%), superficial infection (2%), bruising (1%), seroma (1%), and flattening (8%). ( See table, Supplemental Digital Content 1, which displays the complications. http://links.lww.com/PRSGO/D464 .) Reoperation procedures, wound care, and antibiotics were enough to treat minor complications. Most patients (96%) and the surgeon were very satisfied with the procedure. ( See figure, Supplemental Digital Content 2, which displays a 39-year-old woman. Neoumbilicoplasty was performed 10 days after abdominoplasty. Preoperative photographs show significant fat deposits across the abdomen with central abdominal skin sagging. Postoperative photographs taken 14 weeks after surgery display a slimmer abdomen and a repositioned umbilicus, enhancing the youthful appearance of the anterior torso. Outcomes were evaluated through the Global Aesthetic Improvement Scale. Survey was conducted 90 days after surgery. http://links.lww.com/PRSGO/D465 .) Descriptive Analysis: Patient Demographics and Procedure Details A 39-year-old female patient. Preoperative BMI: 25.9 kg per m 2 . Postoperative BMI: 23.3 kg per m 2 . Procedure: high definition liposculpture + abdominoplasty + neoumbilicoplasty. Lipoaspirate: 7800 mL. Neoumbilicoplasty was performed 10 days after abdominoplasty. A, Preoperative picture showing skin sagging and stretch marks over the abdomen with moderate fat deposits. B, Two-month postoperative photograph showing a natural umbilicus with a new athletic definition of the abdomen.

Umbilicoplasty and neoumbilicoplasty have both undergone progressive and constant changes. Although multiple techniques have been described for neoumbilicoplasty, they all have different advantages/disadvantages. As mentioned by Villegas and Hoyos et al, 10 neoumbilicoplasty affords the surgeon the ability to place the neo-umbilicus in a position that fits the patient’s physique and follows aesthetic standards, regardless of its original position. In fact, patients with significant diastasis recti, short umbilicus, and/or concomitant hernias benefit from forfeiting the old umbilicus followed by neoumbilicoplasty. Such an approach could be considered a great tool after abdominoplasty with liposuction. 1 , 7 – 10 Most umbilicoplasty techniques leave a partial or complete circular outer scar that unveils the blemish of a tummy tuck. 11 Any highly visible scarring in an abdominoplasty could be of significant concern for a certain patient, which tends to result in future complaints. We believe our technique mitigates the issue of such scars by closely mimicking the appearance of a natural navel in its design ( Video 1 ). Some authors mention a 20% complication rate with abdominoplasty plus neoumbilicoplasty, almost half of them related to neoumbilicoplasty itself and 9.7% due to loss of graft integration. 10 One advantage of our technique is the absence of grafting tissue. Although studies have not reported necrosis, any issues with integration could be perceived as graft loss. Therefore, performing a neoumbilicoplasty with flaps instead of a graft appears to have fewer complications. Hoyos et al reported complication rates of 19% and 8.9% for immediate versus delayed X-incision umbilicoplasty, respectively. In comparison, the complication rates for H-wing neoumbilicoplasty were 8.3% for immediate reconstruction and 2.6% for delayed reconstruction. 10 Although it is unclear whether immediate complications in our series resulted from the neoumbilicoplasty or from the abdominoplasty itself, we prefer to perform the umbilicus in a delayed procedure, following the approach described by Hoyos et al. 10 Follow-up was planned for 12 months, and most of the patients included in our study are now more than 6 months postoperative, some actually reaching 18 months postoperative. Due to the retrospective nature of our study, we were unable to precisely differentiate the duration of the neoumbilicoplasty alone because medical records did not specify it. Our study has limitations because its purpose is to report our experience with a new technique for neoumbilicoplasty, rather than to establish a standardized technique, which would have required a larger study with matched patients and a comparison of different techniques. Although we achieved a high satisfaction rate (96%), it is important to note that standardized scores may not be representative of the global population.

The authors have no financial interest to declare in relation to the content of this article.