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The tummy tuck is the most dramatic reshaping method of the lower abdomen for many women after they are finished having children. In the traditional execution of the procedure a skin and fat segment is removed between the hip points with the upper end of the incision going above the umbilicus. This results in the need to uncover the umbilicus by bringing its stalk out through a new opening in the inferiorly positioned skin flap after closure. The telltale signs of the operation are the low long horizontal scar and the much smaller one around or inside the new umbilicus.

While tremendously effective, this type of tummy tuck is excessive for some patients with smaller amounts of skin excess and the desire to avoid a long tummy tuck scar. Enter the limited or mini-tummy tuck patients where the skin excision is kept below the existing umbilicus. This not only keeps the horizontal scar lower and shorter but it also avoids any scarring around the umbilicus. The question then becomes whether the umbilicus stalk should just stretch a bit with the pulled down skin flap or whether a better result will occur if the stalk is severed and allowed to float down with the skin flap and then reattached.

In the March 2019 issue of the journal Plastic and Reconstructive Surgery an article was published entitled ‘Achieving Aesthetic Results in the Umbilical Float Mini-Abdominoplasty: Patient Selection and Surgical Technique’. In this paper the authors review their experience with this limited tummy tuck technique in thirty-one (31) patients over a seven year period. Indications are post-pregnancy women who have moderate skin excess below the umbilicus, some skin laxity above the umbilicus and an otherwise acceptable umbilical shape. The technique was a low skin excision keeping at least a 10cm distance between the umbilicus and the scar line and an umbilical stall lowering between 1 to 3.5 cms internally with emphasis on keeping it just above a horizontal line between the anterior superior iliac spines.

Critical assessment of their results determined that most patients had an initial umbilical position above the midpoint between the xiphoid process and the sternum. After surgery most were slightly below this midpoint. By visual assessment of blinded reviewers almost 20% of the patients were considered to have too low of an umbilical position.

One of the main indications for the umbilical float technique in mini-tummy tucks is the patient with a high preoperative umbilical position. While that can be open to some interpretation, a high position would be considered one that is above a horizontal line drawn between the anterior superior iliac spine points. Another good indication is skin excess above the umbilicus for which floating the umbilicus downward will help to unravel. The two key points that this clinical paper emphasizes is seeing the umbilical stalk position no lower than at the horizontal line between the anterior superior iliac spines and keeping at a 10cm hair-free zone between the umbilicus and the hair-bearing mons pubis.

There are numerous mini-tummy tuck types, most of which either leave the umbilical stalk attached or only detach it to give a full rectus facial plication between the xiphoid down to the pubis. But in the properly selected patients, floating the umbilical stalk may give an improved aesthetic outcome.

Dr. Barry Eppley

Indianapolis, Indiana

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