Background <p>There are few reports on the treatment of umbilical keloids, and the optimal umbilical reconstruction method after keloid resection remains unclear. In cases of umbilical keloid resection involving substantial skin defects, the options for umbilical reconstruction are limited. Herein, we report an innovative technique for umbilical reconstruction after keloid resection.</p> Methods <p>Two patients underwent umbilical keloid excision with simultaneous reconstruction and postoperative radiation therapy. After the excision, a development-view V-shaped skin flap combining the two trapezoids was designed caudal to the defect. A subcutaneous pedicle flap (fat pedicle) was elevated to obtain blood flow from the paraumbilical perforator. It was then moved via a subcutaneous tunnel to the umbilical site and folded into an umbilical shape. The center of the cutaneous flap was sutured to the abdominal wall and the outer circumference was sutured to the resection margin. The donor site was primarily closed. Postoperative radiotherapy (15 Gy) was administered.</p> Results <p>More than one year postoperatively, a vertically shaped umbilicus without keloids was maintained in both cases. Patients expressed satisfaction with the results.</p> Conclusion <p>This novel reconstruction technique is an effective option in cases of umbilical keloids that require excision of the umbilicus with significant skin defect.</p> Level of Evidence V <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors &#xa0;<a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>