The umbilicus is nourished by distinct arterial sources in addition to the subdermal plexus. These deep sources are (1) several small branches off of the left and right deep inferior epigastric arteries and a large ascending branch passing directly to the umbilicus. These branches course between the muscle and the posterior rectus sheath, (2) the ligamentum teres hepaticum, (3) the median umbilical ligament [16], and (4) a group of perforators which approach the umbilicus from various depths of the rectus muscle [17].

This rich vascular anastomosis usually ensures adequate blood supply to the umbilicus during mobilization of reconstructive abdominal flaps. However, during performing an abdominoplasty, the subdermal and the number of the deep arterial sources are interrupted by circumferential incision around the umbilicus. The perforating vessels through rectus muscle convey the remaining blood supply to the umbilicus.

A prospective patient requires a surgeons’ meticulous evaluation in order to choose the correct surgical procedure. The procedure is contingent upon the patients’ skin, muscle, fat content, presence of hernia, and previous abdominal surgical scars. Age, hypertension, cardiac conditions, diabetes mellitus, upper abdominal scars, and excess weight are all relative contraindications to abdominoplasty. It must be emphasized that every patient is not the right candidate for abdominoplasty, and careful consideration is essential and paramount to choose the correct procedure.

Another major deterrent and concern for majority of the surgeons is a patient with a history of smoking [18]. Smoking affects the microcirculation and thereby affects the postoperative healing, apart from the pulmonary effects it has. Prospective patients need to cease smoking at least 2–3 weeks prior to the procedure. As a matter of fact, it is considered a mandatory requirement prior to surgery.

A model candidate for abdominoplasty is a young healthy, physically fit, nonsmoking female. She must be in good general health but carry excess weight in the midsection; bear saggy, loose, and languid skin around the abdomen; and have abdominal protrusion due to laxity of the abdominal wall caused by previous pregnancy, weight fluctuations, aging, stretch marks, and unwanted scars. Notwithstanding, the candidate must commit to maintain the results with proper diet and regular exercise regimen to prevent future weight gain.

According to the American Academy of Plastic Surgeons, in 2001 [19], there were approximately 58,567 abdominoplasties performed in the United States, relating to 4 % of all plastic surgery patients and less than 0.5 % of all plastic surgery procedures. Female patients accounted for 97 % of all abdominoplasties. Most patients were between the ages of 35 and 50 (58 %), with patients under 35 accounting for 20 % and patients over 50 accounting for 22 %. Eighty-two percent of all plastic surgery patients during 2001 were white, 7 % were Hispanic, 5 % were African American, and 5 % were Asian American. As a comparison, in 2012, there were 106,628 tummy tucks performed [20] and 111,986 in 2013 [21]. Clearly, there is an excessive demand for surgical procedures, namely, abdominoplasties, and doubtless these statistics will only annually increase.

The most common complications were wound dehiscence, seroma formation, infection, hypertrophic scarring, residual deformity, and wide umbilical scars. Other complications include skin loss (major or minor), loss of the umbilicus, elevation of the pubic escutcheon, painful neuromas, worsening of gastric reflux due to increased intra-abdominal pressure, and increase risk of deep venous thrombosis resulting from decreased venous blood flow through the common iliac vessels [22].

Potential umbilical reimplantation complications include unsightly scars, cicatricial ring formation, and umbilical stenosis, malposition, or esthetically unpleasing shapes. The umbilical localization alternatives are: