Refinements in abdominoplasty with emphasis on reimplantation of the umbilicus.

First, the author describes the suprapubic deepithelialized triangular flap to eliminate the dead space that can result when the abdominal flap, elevated from the periumbilical zone, meager in fatty tissue, is sutured to the thick pubic region. Second, because of the frequently poor quality of circular periumbilical scars, the author proposes a superiorly based, round-shaped flap taken from the future umbilical location and then defatted. The umbilical cylinder is divided vertically down to its aponeurotic attachment to permit insertion of this round skin flap, which is then anchored to the aponeurosis and to the edge of the triangular gap. This method prevents retracted periumbilical scars. Finally, in secondary corrections after abdominoplasty, satisfactory results can be obtained only if the umbilicus is detached from either the skin or the aponeurosis. The author's technique for covering the hole at the old umbilical location makes use of a round flap from the new umbilical site.