Scarless umbilicoplasty for the prevention of severe hypertrophic scarring of the free abdominal flap in unilateral breast reconstruction

Background: Breast reconstruction using an abdominal flap is the gold standard procedure. However, some patients experience hypertrophy around the edge of the umbilicus wound. This can narrow the entrance of the umbilical fossa. To avoid this, we present our scarless umbilicoplasty procedure. This study aimed to investigate the efficacy of scarless umbilicoplasty for the patients who underwent unilateral breast reconstruction with a free abdominal flap. Methods: 163 patients who underwent scarless umbilicoplasty (scarless plasty [+]) and 120 patients who did not, were compared. The scarless umbilicoplasty procedure was as follows. After harvesting the flap, an anchoring mattress suture was performed between the wound edge of the umbilicus and the abdominal wall. This was retained to be untied. The patient was placed in a beach chair position, and a vertical incision was made in the abdominal skin. The abdominal subcutaneous fat was resected from the wound edge of the incision. The old umbilical fossa was exposed through the incision space and dermostitched to the abdominal dermis using the retained suture. Results: The rate of umbilical wound dehiscence was significantly higher in the scarless plasty (+) group (11.0% vs. 2.5%, P = 0.006). The mean modified Vancouver Scar Scale ( 0.7 ± 1.2 vs. 2.3 ± 2.0, p < 0.001) and the rate of hypertrophy (1.8% vs. 9.2%, p = 0.01) were significantly lower in the scarless plasty (+) group. Conclusions: Scarless umbilicoplasty can decrease postoperative scar hypertrophy that narrows the umbilical fossa entrance.