Monday, January 25, 2010

Neoumbilicoplasty

The umbilicus is perhaps the only scar that all of us want.  The umbilicus forms after birth as a result of the placental cord being transected as the infant is “detached” from his/her mother.  As the stump of the cord necroses, the scab falls away as the base heals leaving a scar:  the umbilicus.

The umbilicus has been described as a depressed scar surrounded by a natural skin fold that measures 1.5 to 2 cm in diameter and lies anatomically within the midline at the level of superior iliac crest.

Neoumbilicoplasty in simple terms is the creation or reconstruction of a new umbilicus to replace the missing or deformed umbilicus.  (absence of defined umbilicus, photo credit)

 

Craig et al. reported on the ideal female umbilicus, but it should always be remembered  “the ideal umbilicus should be regarded as one that is satisfying to the patient.”  (photo credit)

The most aesthetically pleasing umbilicus is small in size, T or vertical in shape, and possesses a superior hood or shelf.

Those characteristics found to be unappealing include a large overall umbilical size, a horizontal or distorted shape, and the presence of umbilical protrusion.

In reconstructing the umbilicus, plastic surgeons should strive to attain these attractive characteristics and incorporate a modest size, with a superior shelf or hood and a T or vertical shape.

Reconstruction of a new umbilicus is indicated in congenital conditions associated with umbilical agenesis, loss of umbilicus due to omphalocele or gastroschisis repair, umbilical loss due to inflammatory destruction, excision of skin cancer involving the umbilical stump, and in surgical procedures for wide ventral herniorrhaphy.

In my humble opinion, the site of the new umbilicus should correspond to where “nature” would have placed it.  If there is any of the old umbilicus present, this can be used as an indication of where the new umbilicus should be placed.  If not, then  Dr. Susam Park, et al has this suggestion:

Based on our study, it is usually 3 cm above the level of the anterior superior iliac spine in a baby and 6 cm above in an adult, although differences in height and weight may affect these measurements.

Or as  Dr. Suhas Abhyankar, et al put it:

1. The distance between the xyph0sternum and umbilicus-distance between the umbilicus and the pubic symphysis ratio is approximately 1.6:1.

2. Also, the distance between the umbilicus and the anterior superior iliac spine-distance between the right and left anterior superior iliac spines ratio is 0.6:1.  This implies that when each of the anterior superior iliac spines is taken as a center, and arcs are drawn with a radius 0.6 times that of the inter-anterior superior iliac spine distance, the point of intersection of these arcs is the location of the umbilicus, taking into consideration the above ratio (1.6:1).

 

Surgery varies depending on whether a completely new umbilicus is being created or simply an “outie” being turned into an “innie” or maintaining the umbilicus with other surgery (ie abdominoplasty).

 

 

  

REFERENCES

*****After noticing the first referenced article below on MDLinx, I did a search of articles in the Journal of Plastic and Reconstructive Surgery first using “neoumbilicoplasty” and then “umbilical reconstruction.”  The second gave me a great list of articles (only a few listed below).

 

Neoumbilicoplasty is a Useful Adjuvant Procedure in Abdominoplasty; Can J Plast Surg 2009; 17 (4): e20-e23; AA Al-shahan

In Search of the Ideal Female Umbilicus; Plast Reconstr Surg 105: 389, 2000; Craig, S. B., Faller, M. S., and Puckett, C. L.

New Technique for Scarless Umbilical Reinsertion in Abdominoplasty Procedures; Plast Reconstr Surg 102(5):1720-1723, 1998; Schoeller, Thomas M.D.; Wechselberger, Gottfried M.D.; Otto, Angela M.D.; Rainer, Christian M.D.; Schwabegger, Anton M.D.; Lille, Sean M.D.; Ninkovic, Milomir M.D.

A Simplified Technique for Umbilical Reconstruction; Plast Reconstr Surg 114(2):619-621, 2004; Korachi, Ali; Oudit, Deemesh; Ellabban, Mohammed

Umbilical Reconstruction after Repair of Omphalocele and Gastroschisis; Plast Reconstr Surg  104(1):204-207, 1999; Park, Susam; Hata, Yuiro; Ito, Osamu; Tokioka, Kazuyuki; Kagawa, Koji

Simplified Technique for Creating a Youthful Umbilicus in Abdominoplasty; Plast Reconstr Surg 109: 2136, 2002; Lee, M. J., and Mustoe, T. A.

Anatomical Localization of the Umbilicus: An Indian Study; Plast Reconstr Surg 117(4):1153-1157, 2006; Abhyankar, Suhas V.; Rajguru, Anirudha G.; Patil, Prajakta A.

Placement of the Umbilicus in an Abdominoplasty;  Plast. Reconstr. Surg. 61: 291, 1978; Dubou, R., and Ousterhout, D.

Umbilical Reconstruction in Abdominoplasty; Melvin A. Shiffman;  International Journal of Cosmetic Surgery and Aesthetic Dermatology. September 2000, 2(3): 171-176. doi:10.1089/153082000750062830

3 comments:

StorytellERdoc said...

You just know I had to pull up my shirt and look at my belly button this morning after reading your post, right? LOL Good post...
Jim

Midwife with a Knife said...

I have to wonder how much people are willing to pay for neoumbilicoplasty. :) Of all of my body parts I would miss, I don't think my umbilicus is even in the top 5. :) Having said that, I can understand how it would suck if you were a teenager (maybe with a history of an omphalocele repair or something) without a belly button in the locker room....And it does make a handy landmark for docs. :)

emmy said...

So I'm not crazy. I have thought that my surgeon did a wonderful job reconstructing my breast, but put my umbilicus in the wrong place.