After having full-term twins, I developed a small umbilical hernia, separated muscles and now have extra skin and stretch marks. I've seen two plastic surgeons. The first said he would perform the full abdominoplasty and hernia repair, but leave me without a belly button. After a few months of healing, he would add the belly button, which he said could be done in his office. The second surgeon said he would create my new belly button during the initial surgery. Which is the better approach?
Should the Belly Button Be Added Before or After my Abdominoplasty?
Doctor Answers 12
A Belly Button Saved is a Belly Button Earned
Although the adult belly button does not particularly contribute significantly to any physiologic purpose, it does serve as an anatomic landmark that is met with some degree of visual expectation from a social perspective.
With that in mind, and from a purely theoretical standpoint, I believe that most of us would instinctively prefer to preserve the belly button of our patients whenever possible when we are performing a tummy tuck with and without a hernia repair, and, from a practical standpoint, most of us are able to and do, purposely, preserve the belly button when we perform a tummy tuck with and without a hernia repair.
I suppose that I would entertain sacrificing/removing/amputating the belly button during a tummy tuck with or without a hernia repair if there was a clinical situation wherein either the belly button skin and/or blood supply was so damaged before surgery such that its preservation after surgery was not likely or indicated(and, therefore, not in the best interests of the patient) or if I felt that, despite the absence of any impairment before surgery, conditions during surgery would most likely lead to a physical impairment of the belly button's blood supply (as a result of the presence of too much remaining extra-abdominal fat and tension on the belly button stalk) following routine surgery (.i.e belly button preservation) and that the belly button would not, ultimately, survive.
Despite over perhaps 50+ scientific papers written on the subject of belly button reconstruction/recreation, I believe that there is no better substitute for the belly button than the belly button itself.
Beware of the Belly Button Bandit!
Even with a "small" -- or large -- umbilical hernia, the belly button (umbilicus) is not typically removed during a tummy tuck. It is quite common to repair even a large umbilical hernia during tummy tuck surgery. Without seeing you, I cannot know the specifics of your case, but the umbilical hernia should be repaired and the belly button should be restored during your tummy tuck surgery. Re-shaping a stretched or distorted umbilicus is often part of routine abdominoplasty surgery.
"Adding" belly button during or after tummy tuck and umbilical hernia repair?
Unless your umbilical hernia is very large (completely pushing out your umbilicus) or has been operated on several times with scarring and decreased circulation, removing your belly button at the time of tummy tuck and "adding" a new one later is an unusual, rare, (but not entirely unreasonable or unheard-of) approach.
The vast majority of experienced plastic surgeons will repair your umbilical hernia at the time of tummy tuck and muscle sheath plication, and restore your own umbilicus (usually much better than what even the most gifted plastic surgeon can create or "add" later) to its same position with "new" tightened skin around it.
Get additional in-person opinions from experienced ABPS-certified plastic surgeons and the "correct" answer should become apparent. Best wishes!
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Belly button is best preserved during tummy tuck surgery
Thank you for your question. It is extremely difficult to create a belly button that looks as good and natural as your own belly button. It is usually possible to create a very nice "inny" belly button during a full abdominoplasty. I would prefer to have a general surgeon repair your umbilical hernia during the course of the tummy tuck and I would reestablish your new bellybutton to an appropriate location following the removal of excess skin and the full tummy tuck procedure.
No Belly Button? How strange
Aesthetically, the belly button is pretty important. Granted, there is no great physiologic reason for the adult belly button, but just think how strange we would all look without one! Now, even though it may be a short time period spent without one (your first surgeon's suggestion), it probably is an unnecessary approach, although without examing you, it's difficult to be completely sure. It is not uncommon to fix an umbilical hernia during an abdominoplasty, and be able to successfully perform the remainder of the surgery at the same sitting. That said, it does increase the risks of the procedure a small amount. But the majority of times, this risk is miniscule if performed by a competent, board certified surgeon. I would suggest that the reason for the case in the first place is to improve the aesthetics of your midsection, so why make it look "off" without a belly button, if it doesn't have to be done? Your board certified surgeon will be able to guide you in your choice. Good Luck.
Tommy Talk and Umbilical Hernia Repair?
Thank you for the question.
Repair of an umbilical hernia is not infrequently necessary when performing a tummy tuck operation. The bellybutton should be preserved and “reconstructed” to look as normal as possible. There is generally no need for a two-stage procedure.
Generally, the appearance of the umbilicus after tummy tuck surgery is of critical importance to many patients. Essentially, it is the only scar visible when patients are wearing undergarments or swimming suits. It can be a telltale sign of a patient who has had abdominal plastic surgery. As much as possible, it is best to keep the belly button relatively small, oval shaped, and attempt to hide the resulting scars.
I hope this helps.
Should my belly button be removed during tummy tuck and a new one made later?
I have not heard of removing a belly button at the time of a tummy tuck, even in the presence of an umbilical hernia, and then making a new one at the same time or at a later procedure. What I, and I suspect most plastic surgeons, do is to repair the umbilical hernia at the time of the tummy tuck, preserving the belly button and trying to make an "inny" and a smaller, less stretched out belly button. It is true that taking the umbilical stalk apart to repair a large hernia can risk the blood supply to the belly button skin and cause a loss of the belly button, but in my practice we avoid that by working with a general surgeon who approaches and repairs the umbilical hernia from underneath the fascia, thus avoiding taking the umbilical stalk itself apart. In my opinion, making a new belly button from scratch, although sometimes looking pretty good, is seldom going to look as natural as preserving and repairing your current belly button.
Waste (belly button) not, want (want belly) not
There is no need to discard a perfectly good belly button. Regardless of umbilical hernia, the belly button can be repaired and used. Although creating a new belly button can aesthetically successful, it is an unecessary step. I recommend repairing the hernia at the same time as the tummy tuck and rejuvenating the belly button shape to match your new tummy.
All the best,
Dr. Remus Repta
Should the Belly Button Be Added Before or After my Abdominoplasty?
As always please post your photos with your questions/concerns/issues. In general I know of no boarded PS would would sacrifice an umbilicus unless you have a very very large hernia. So the first doc you saw sounds very different. Plus I could not "make" a new BB in my office under local. Be careful out there.
Belly button usually not removed during tummy tuck
Without photographs or without physical examination, it would be impossible to comment specifically on your case. However, generally speaking, your own belly button is left intact during an abdominoplasty even with repair of umbilical hernia. However, it is possible that the umbilical hernia is so large that it has completely eradicated your own belly button and another one has to be created surgically. When it is done would be the preference of the surgeon.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.