Improving the Result of the Umbilicus in the Thin Multiparious Woman Undergoing Abdominoplasty
One of the more challenging cosmetic surgery goals is to obtain depth of the umbilicus in the thin multiparious woman when performing abdominoplasty. The technique described allows for a predictable and natural appearing umbilicus in the patient population that has a stretched out belly button and very little subcutaneous fat.
After elevation of the abdominal flap, two percutaneous horizontal mattress sutures of 3-0 vicryl tack the center of the umbilicus superiorly and inferiorly to the fascia. This fixes the base of the umbilicus and preserves the lateral blood supply. Next, a midline plication is performed with interrupted figure-of-eight 2-0 or 0 ethibond suture. This forms a trough that restores depth to the umbilicus. The umbilicus is incorporated into the superior and the inferior figure-of-eight suture. The remainder of the abdominoplasty is performed in the usual fashion.
Even though a few mm of the Vicryl suture are exposed, this has never been a problem. In fact, I have never seen the suture in a post-op patient.
I routinely use this technique in those patients who have an elongated umbilicus. The blood supply is preserved and the umbilicus is shortened and fixed to the underlying fascia.