Lymphatic pathway remodeling in the supraumbilical region after abdominoplasty: A prospective cohort study

The level of the umbilicus is considered a watershed between the axillary and superficial inguinal nodal basins. Flap elevation during abdominoplasty may disrupt the continuity of lymphatic flow. In this study, we aimed to evaluate lymphatic drainage and remodeling of the supraumbilical skin flap in patients undergoing lipoabdominoplasty.

This prospective cohort study was conducted in 15 female patients scheduled for lipoabdominoplasty. The abdominal skin was divided into four quadrants. Intradermal Tc-99m nanocolloid was injected into each quadrant; pathways were assessed using dynamic lymphoscintigraphy, followed by single-photon emission computed tomography/computed tomography. At postoperative month 6, the same protocol was repeated with injections performed in a manner corresponding to the supraumbilical skin flap proximal to the incision line.

The median age of the 15 female patients was 37 years. Preoperatively, 93.3% of upper quadrant injections drained to the axillary lymph nodes bilaterally, whereas all lower quadrant injections (100%) drained to the inguinal lymph nodes. At postoperative month 6, 5 of 15 patients (33.3%) demonstrated postoperative lymphatic variations, such as dual, delayed, collateral deep drainage, or complete redirection to the inguinal basin, on at least one side. A history of breast reduction was significantly associated with lymphatic variation (p = 0.022).

After lipoabdominoplasty, axillary drainage of the supraumbilical skin flap was preserved in most patients; however, a clinically relevant subgroup developed new drainage patterns. These findings demonstrate the remodeling capacity of the lymphatic system after abdominoplasty and indicate that truncal lymphatic drainage is a dynamic structure sensitive to surgical intervention.