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VIEWPOINTS

Do Waistline and Umbilical Position Really Change after Abdominoplasty?

Chin, Simon H. M.D.; Martin, W Jason M.D.; Matarasso, Alan M.D.

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Plastic and Reconstructive Surgery: January 2010 - Volume 125 - Issue 1 - p 27e-28e
doi: 10.1097/PRS.0b013e3181c2a2e9
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Sir:

Do the horizontal and vertical dimensions of the trunk truly change after abdominoplasty? Previous studies have focused on the umbilical position during preoperative evaluation, but alterations in waistline size, trunk dimensions, and umbilical position following abdominoplasty have not been evaluated thoroughly.1,2 This study sought to investigate these changes following traditional full abdominoplasty.

Baseline measurements were obtained preoperatively that included waist circumference at the level of the umbilicus and distances from the xiphoid to the umbilicus and from the umbilicus to the most superior aspect of the labia majora (Fig. 1). Eleven female patients with abdominal lipodystrophy ranging in age from 28 to 72 years were treated with a standard full abdominoplasty procedure over a 6-month period (June of 2005 to January of 2006) by a single surgeon (A.M.), according to previously published methods at the Manhattan Eye, Ear and Throat Hospital.3,4 Postoperative measurements at 1 week and 6 months were then recorded.

Fig. 1.
Fig. 1.:
Measurements obtained preoperatively and postoperatively. W, waist circumference at the level of the umbilicus; XU, distance from the xiphoid to the umbilicus; UV, distance from the umbilicus to the superior aspect of the labia majora. (Courtesy of Thanapong Waitayawinyu.)

All 11 patients completed the study without complications. There were statistically significant net reductions in waist diameter (net mean decrease of 5.0 cm at 7 days and 7.9 cm at 6 months), xiphoid to umbilical distance (net mean decrease of 2.2 cm at 7 days and 2.8 cm at 6 months), and umbilicus to labia majora distance (net mean decrease of 4.4 cm at 7 days and 5.09 cm at 6 months) (Table 1).

Table 1
Table 1:
Measurements of Waist Circumference, Xiphoid to Umbilicus, and Umbilicus to Superior Aspect of Labia Majora

Van Uchelen et al. evaluated the long-term durability of plication with ultrasonography. Six percent of the patients felt that their waist had gained in size, 60 percent felt it was unchanged, and 33 percent felt their waists had become slimmer.5

Our study is limited because of the small study group and does not take into account changes in diet or exercise or use fixed bony reference points. However, the data demonstrate consistent reductions in waist diameter (net mean decrease of 5.0 cm at 7 days and 7.9 cm at 6 months), xiphoid to umbilical distance (net mean decrease of 2.2 cm at 7 days and 2.8 cm at 6 months), and umbilicus to labia majora distance (net mean decrease of 4.4 cm at 7 days and 5.09 cm at 6 months). Comparison of preoperative and postoperative circumferential waist measurements revealed a significant decrease following plication that tightens the rectus fascia in the horizontal vector and persists because of the continual resolution of postoperative edema.

This study also shows that the position of the umbilicus is displaced cephalically following abdominoplasty. Vertical plication and the superior pull of the tightened skin flap shortens the distance between the xiphoid and the umbilicus.

Finally, our data display the decrease in distance between the umbilicus and the labia majora postoperatively. Removal of excess abdominal tissue below the umbilicus decreases the distance between the two points. The vertical pull of the infraumbilical rectus plication combines with the former to pull on the mons, which rejuvenates the aging vulva by unraveling and elevating the mons ptosis.

This study demonstrates reductions in waist diameter and vertical trunk dimensions along with changes in umbilical position after abdominoplasty that persist at 6 months after surgery.

DISCLOSURE

The authors have no financial interests to declare in relation to the content of this article.

Simon H. Chin, M.D.

W. Jason Martin, M.D.

Department of Plastic Surgery; Manhattan Eye, Ear and Throat Hospital; Institute of Plastic and Reconstructive Surgery; New York University School of Medicine

Alan Matarasso, M.D.

Department of Plastic Surgery; Albert Einstein College of Medicine, and Manhattan Eye, Ear and Throat Hospital; New York, N.Y.

REFERENCES

1. Rohrich RJ, Sorokin ES, Brown SA, Gibby DL. Is the umbilicus truly midline? Clinical and medicolegal implications. Plast Reconstr Surg. 2003;112:259–263.
2. Tercan M, Bekerecioglu M, Dikensoy O, et al. Effects of abdominoplasty on respiratory functions: A prospective study. Ann Plast Surg. 2002;49:617–620.
3. Matarasso A. Abdominoplasty. In: Guyuron B, Achauer BM, Eriksson E, et al., eds. Plastic Surgery: Indications, Operations, Outcomes. Vol. 4. Philadelphia: Mosby-Yearbook; 2000:2783–2821.
4. Matarasso A. Liposuction as an adjunct to a full abdominoplasty revisited. Plast Reconstr Surg. 2000;106:1197–1202.
5. van Uchelen JH, Kon M, Werker PM. The long-term durability of plication of the anterior rectus sheath assessed by ultrasonography. Plast Reconstr Surg. 2001;107:1578–1584.

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