H-wing Neoumbilicoplasty: A New Technique for Advanced Abdominoplasty and Umbilical Zones by Gender

Abstract

Background: Multiple umbilicoplasty techniques have been described, even more after the advent of full tummy tuck procedures and the neoumbilicoplasty (X-shaped incision) described by the authors in a previous report. The authors decided to upgrade the technique (H-wing incision) because the former procedure is associated with relatively common complications. The authors report a case series of an upgraded technique for neoumbilicoplasty (H-wing technique), comparing its outcomes with their previous standard procedure (X-shaped incision). Methods: The authors reviewed their records for neoumbilicoplasties performed between January of 2014 and December of 2019. The authors divided the procedures according to the surgical technique and performed a detailed analysis regarding timing, complications, uses, and quality standards according to patients’ opinion through a nonstandardized survey. Results: A total of 407 procedures were distributed between two techniques: X-shaped incision, 179 procedures; and H-wing technique, 228 procedures. The former was performed from January of 2014 to October of 2016 and the latter from September of 2016 to December of 2019. High satisfaction indexes were found for both procedures; however, fewer complications were seen in the H-wing group. The X-shaped incision is thought to generate a greater force of tension over the flaps compared to that from the H-wing technique, which consequently increased the risk of flap necrosis and flattening. Conclusions: The H-wing technique for neoumbilicoplasty decreases the risk of postoperative complications such as dehiscence, skin necrosis, and navel flattening, and maintains high aesthetic standards and satisfaction indexes among patients. The technique can be used after either lipoabdominoplasty or secondary procedures.

Female Abdominal Landmarks and Their Improvements Using Polydioxanone Thread Placement for Umbilicus Elevation

“…In other words, although useful, AU/ UC ratios are not the sole determinant of abdominal aesthetics. This notion is supported by Hoyos et al, 15,34 who advocated that a zone of umbilicus locations should be allowed after abdominal makeover.…”

“…http://links.lww.com/PRSGO/C868.) 2,8,[10][11][12][13][14][15][16][17][18]23,24,31,[34][35][36][37] We advocate that standing AU/UC be used for visual guidance to gauge preoperative deficiencies and postoperative results, serving both patients and surgeons. At the same time, we also suggest that the XU/UP and UIC (standing) be used as feasible guides for surgical planning.…”

Determination of Appropriate Umbilicus Position during Abdominoplasty in Male Patients

“…Ideal position has been debated for decades, and general consensus is still lacking. 6,10,17 Hoyos et al 7,8 reported that three localization modalities are mostly favored: (1) at 60% of the distance between the pubis and xiphoid process, measured from distal to proximal 24 ; (2) at the intersection between the midline and a line crossing both anterosuperior iliac spines 25 ; and (3) at a point located 15 cm above the pubic bone. 26 In many anatomical descriptions, the transumbilical plane is described at the level between the third and fourth lumbar vertebrae in the supine position regardless of gender.…”

“…5 If absent or not well-positioned, it can result in an unnatural looking abdomen. 2,4,[6][7][8][9] Despite that its physiological and aesthetic importance have long been recognized, the umbilicus was routinely discarded during surgery until the late 1950s. 10,11 With increasing appreciation of its importance in defining a harmonious anterior trunk, umbilical transposition performed toward the end of the surgery was described by Vernon in 1957.…”

Crafting Illusions: The Art of Neoumbilicoplasty in DIEP Patients

“…4 Hoyos et al recently published the concept of the two-thirds to one-third umbilical position, by measuring the distance from the xiphoid to the pubis in abdominoplasties. 5 In DIEP flaps, the low transverse abdominal incision is usually marked in a location that will allow for dissection of the dominant perforator and for tension-free closure. Thus, the relation between the abdominal scar and the original umbilical site does not always follow the rules for umbilical transposition in abdominoplasties.…”