Facilitated Umbilical Positioning in Abdominoplasty Using the 15/10 Rule and the "Flap Flipping" Technique

Abstract

First described by Gaudet and Morestin, abdominoplasty with umbilical preservation dates as far back as 1905. Navel position was described on the transverse axis by Rohrich, and on the median longitudinal axis, by Vernon, Baroudi and Pitanguy. The aim of this article is to validate the 15/10 rule of umbilical positioning in abdominoplasty with the "flap flipping" technique, as an intraoperative aid to simplify umbilical repositioning. Between October 2019 and March 2020, 18 consecutive patients underwent full abdominoplasty, using the 15/10 rule for umbilical positioning. Patients' average age was 47.9, with body mass index 27.5 kg/m² and height 1.63 m. An "expected zone" of umbilical position was delineated by 2 horizontal lines, 15 cm from the bra line and 10 cm from the pubic level. The umbilicus was accurately positioned by using the flap flipping technique before closure of the inferior abdominal incision line. It was then examined to determine whether the umbilicus was situated in the expected zone. In 14 of 18 patients, intraoperative and postoperative measurements of umbilical position were in the expected zone. An average 15.19 cm was measured between the bra line and the new umbilical positioning, and 12.02 cm from the new umbilicus to the pubic inferior suture line. We find that the 15/10 rule of umbilical positioning with the flap flipping technique is an important, intuitive, and easy-to-use guide for precise umbilical positioning in abdominoplasty.

Fig. 1.

Natural umbilical position and expected positioning zone. A, Preoperative abdominal surface representation showing the landmark points of the different measurements: preoperative skin and AerialBU and UP measurements, postoperative BUcenter and UcenterP measurements. B, 10/15 rule of umbilical positioning and expected zone.

Fig. 2.

15/10 rule of umbilical positioning in abdominoplasty. A, Preoperative. B, Intraoperative, 15/10 marks on abdominal wall and expected zone; notice umbilical position in the expected zone. C, Immediate postoperative; notice ecchymosis.