Earplug Umbilicoplasty: A Simple Method to Prevent Umbilical Stenosis in a Tummy Tuck

Swapnil Kachare, MD, MBA; Christina Kapsalis, BS; Milind Kachare, MD; Andrea Hiller, BS; Sara Abell, BS; Thomas J. Lee, MD; Bradon J. Wilhelmi, MD, FACS

Disclosures

ePlasty. 2019;19(e12) 

In This Article

Abstract and Introduction

Abstract

Objective: An aesthetically pleasing umbilicus is a vital component of patient satisfaction following an abdominoplasty. An umbilicus that is moderate to small is desired to achieve the best aesthetic result, but a small umbilicus has potential for stenosis. This article presents a method for umbilical stenting that creates a modest umbilicus, while preventing stenosis.

Methods: All patients underwent abdominoplasty with an umbilical reconstruction using an inverted U-flap method between 2015 and 2017. An earplug was placed into the umbilicus at 2 weeks postoperatively for a total of 4 to 6 week. Patients were evaluated subjectively on the aesthetic outcome.

Results: Twenty-one female patients were evaluated 6 weeks postsurgery. In all cases, both the patient and the surgeon were 100% satisfied with the final size. Umbilical size ranged from 1.8 to 2.2 cm.

Conclusions: Use of an earplug for umbilical stenting is a simple and reproducible method to create an aesthetically pleasing umbilicus and avoid stenosis.

Introduction

Abdominoplasty has consistently remained one of the top cosmetic surgical procedures, with more than 127,500 procedures performed in 2016.[1] During this procedure, the umbilicus is repositioned within the abdominal skin flap. Transposition of the umbilicus is also a component of procedures that involve autologous breast reconstruction using abdominal tissue, such as transverse rectus abdominis myocutaneous (TRAM) or deep inferior epigastric perforator (DIEP) flaps. Although umbilicoplasty may seem to be a minor component of these procedures, it is absolutely critical for obtaining the most cosmetically pleasing result. The final aesthetics of the umbilicus can ultimately influence patient satisfaction with the procedure, and a poor result can ruin an otherwise successful abdominoplasty.[2]

When glancing at an aesthetically pleasing female abdomen, the umbilicus is the central focus.[3] It is a unique structure in that it is the only naturally occurring scar in the human body.[4] The umbilicus is considered by many to be an aesthetic subunit in and of itself.[5,6] When absent, misshapen, or displaced, it can create an unnatural looking abdomen that causes undue attention to the midsection, resulting in psychological distress for the patient.[7] Position, size, shape, and depth of the umbilicus are characteristics that contribute to the overall aesthetics of the abdomen.[8]

Because of the negative aesthetic perception of a large and wide umbilicus, plastic surgeons attempt to create a modest umbilicus during umbilical reconstruction. However, the process of skin healing and scar remodeling varies from person to person, making complications unpredictable; thus, a relatively small umbilicus may become stenotic and distorted. Despite this commonly anticipated problem, there is no standardized approach to dealing with umbilical stenosis. We present a method of umbilical stenting that allows the surgeon to create a modest umbilicus while also avoiding the complication of umbilical stenosis.

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