Periumbilical Fascioplasty Improves Postabdominoplasty Umbilical Perfusion: An Approach to Reducing Umbilical Necrosis

Abdominoplasty represents one of the most recognized operations performed by plastic surgeons. Despite its long history and ubiquity, the procedure retains a largely individualistic component, affected by a surgeon's artistry as much as by known clinical approaches. Consequently, complication incidence reporting has been variable, particularly that of umbilical dehiscence. This study aims to demonstrate the incorporation of periumbilical fascioplasty to reliably limit umbilical necrosis, particularly in cases where maximal rectus plication is desired. We present a series of 30 patients who underwent abdominoplasty at a single center under 1 surgeon between 2021 and 2024. Abdominoplasties were performed in standard fashion. Following extensive midline abdominal wall plication, the umbilicus is identified deep within the plication. Periumbilical fascioplasty is then performed by incising the anterior rectus fascia circumferential to the position of the umbilicus, releasing any adherences to the underlying rectus muscle, and suturing the imbricated anterior rectus fascial segment onto the anteriorly exposed fascia, thereby anteriorly transposing the base of the umbilicus. This further eliminates the compression caused by the vertical vector of traditional midline plication while simultaneously displacing the umbilical base anteriorly. Abdominal skin is then transposed, and the umbilicus is externalized in the desired fashion. This approach resulted in 0 cases of umbilical skin necrosis and dehiscence. Although approximately 15 additional minutes are required in this process, the reduced need for follow-up corrective surgery should be considered. In applying this protocol, a surgeon may be more confident that they may achieve maximum midline plication while improving umbilical survivability metrics.