Plastic Surgery Research Council

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The Trompe l'Oeil Effect: Neo-umbilicoplastyin The Reconstructive Population
Ledibabari M. Ngaage1, Georgios Kokosis, MD2, Rachel Pedreira, BA3, Erin M. Rada, MD1, Yvonne M. Rasko, MD1.
1University of Maryland Medical Center, Baltimore, MD, USA, 2Johns Hopkins Hospital / University of Maryland Medical Center, Baltimore, MD, USA, 3Johns Hopkins University School of Medicine, Baltimore, MD, USA.

PURPOSE:
The umbilicus is the centrepiece of the abdomen and an important cosmetic landmark. Studies describe the "ideal" umbilicus but neglect to focus on patient self-assessed aesthetic outcomes. Although the umbilicus is often amputated to prevent vascular compromise during reconstructive abdominal surgery, neo-umbilicoplasty is not commonly employed. Yet, it is almost standard procedure in cosmetic surgery (abdominoplasty). Secondary intention healing (trompe l'oeil effect) can be used to create the illusion of an umbilicus in reconstructive surgery. There is, however a sparsity of literature on the role of neo-umbilicoplasty in this subset of patients and how they perceive their new umbilicus. 
METHODS:
We conducted a retrospective review of patients who received a neo-umbilicus during an abdominal reconstructive operation in 2016-2018 by a single plastic surgeon at a tertiary medical center. Patients with reservations about the loss of their umbilicus in the setting of a distorting umbilical hernia or prior hernia repair with transection of umbilical stalk, were offered the option of having a neo-umbilicus created at the time of their abdominal surgery. The umbilicus was amputated intraoperatively and tacking sutures were placed to create an indentation in the soft tissue in the location of the native umbilicus, and then an inverted V incision was performed and sutured to create the illusion of an umbilicus. Post-operatively patients were asked to rate their satisfaction with umbilicus appearance on a five-point Likert scale. Data was collected on patient demographics and operative details.
RESULTS:
Ten patients met the inclusion criteria for this study. The majority were female (9:1), with a mean age of 37 years (range 26-50) and mean BMI 29 (range 21-38). 80% of patients had carried a prior pregnancy, and 90% had a history of prior abdominal surgery. Median number of previous abdominal surgeries was 1.5 (range 0-5). The most common procedure performed at time of neo-umbilicoplasty were hernia repair (70%) and diastasis recti repair (70%). There were no wound complications associated with the neo-umbilicus. Satisfaction score was high (median 5, range 1-5) and independent of time since surgery. 3/10 patients who scored their results with lower satisfaction scores, their reasons included lack of indentation (n=3, scores 4, 4, and 1), and insufficiently notable scar (n=1, score 1). Of note, the same patient scored the lowest scores in the above categories.
CONCLUSION:
We hereby describe a simple surgical technique for neo-umbilicoplasty in patients undergoing abdominal wall reconstruction with umbilical stalk amputation that leads to long-lasting cosmetic satisfaction. Further studies of patient-reported outcomes and refinement of the technique to meet these demands will maximize the aesthetically pleasing results.


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