Umbilical Reconstruction Techniques in Abdominoplasty: A Systematic Review of Aesthetic Outcomes and Complications

Background: Umbilical reconstruction is a critical step in abdominoplasty, with significant impact on aesthetic outcomes and patient satisfaction. Although numerous techniques have been described, no consensus exists regarding the optimal approach in terms of safety and cosmetic results. Objective: To compare the most frequently used umbilical reconstruction techniques in abdominoplasty based on complication rates and aesthetic satisfaction through a systematic review and meta-analysis. Methods: This review followed the PRISMA 2020 guidelines. A systematic search was conducted across PubMed, Scopus, Web of Science, Google Scholar, SciELO, and LILACS up to June 2025. Clinical studies comparing umbilicoplasty techniques and reporting outcomes such as necrosis, retraction, dehiscence, infection, and aesthetic satisfaction were included. Risk of bias was assessed using RoB 2.0 for randomized trials and the Newcastle–Ottawa Scale for observational studies. A descriptive synthesis and comparative analysis were performed. Results: Ten studies met the inclusion criteria, with a total of 510 patients. Techniques such as Mercedes‑Y, MUC (3-step), and house-roof achieved the highest aesthetic satisfaction scores (≥8.9/10) and showed the lowest complication rates (necrosis 0 %, dehiscence ≤3 %). In contrast, circular and oval techniques were associated with lower satisfaction (6.7–7.2/10) and higher rates of retraction or visible scarring. Techniques with deep fascial fixation or anatomical design consistently yielded superior cosmetic outcomes. Conclusions: Structured anatomical techniques with deep fascial fixation, such as Mercedes‑Y, house-roof, and MUC, provide the best combination of safety and aesthetic results in umbilical reconstruction. Their use is recommended in patients with thin abdominal walls, flaccidity, or aesthetic demands. Further controlled studies with validated outcome measures and long-term follow-up are needed to standardize surgical guidelines.