What is the difference between traditional tummy tuck where cut outside around button and new techniques where button is floated underneath? My doc says can put back same place and reattach stalk? Whole idea bugs me but not sure why? Can you work around the stalk to get to upper muscles and not cut it or does the stalk have to be cut because it is in the way? Only other option is endoscopic which not really done right? Does the stalk serve any purpose my doc says no issue because reattached.
Difference Between Traditional Tuck and Floating? Are There Any Issues With Reattaching The Belly Button?
Doctor Answers (20)
The Umbilical Float vs. Traditional Transposition
The ideal candidate for a full tummy tuck is one who has moderate to severe excess skin in the upper and lower abdomen with associated laxity in the muscles and fascia. A low transverse incision is made and a lower abdominal skin flap is raised. To access the upper abdomen, a circular incision around the belly button is made – leaving it attached to the abdominal muscle wall by its stalk, which is now its sole source of blood supply. Access to the upper abdomen is now present, and the upper abdominal skin is raised to expose the full length of the rectus muscles. Full length muscle tightening (plication) is performed. The abdominal skin is pulled down to tighten it, and the excess lower abdominal skin is removed. Before completing the skin closure, a small circular opening is made in the abdominal skin so the belly button can be brought through the skin and sewn in place. The vertical location of the belly button on the abdomen does not change because it remains attached by its stalk, but there is a circular scar around it.
A mini-tummy tuck is for patients that have minimal lower abdominal skin excess and little or no looseness in the muscles and fascia. A shorter low transverse incision is made; a small lower abdominal skin flap is raised and dissection does not extend above the belly button. The skin is pulled down to tighten it, the excess removed, and the skin closed. There is no incision around the belly button and it remains attached by its stalk as well.
If patients undergoing a mini-tummy tuck also have mild looseness in the lower muscles and fascia, the lower muscles can be gently tightened. There may be limitations to the amount of tightening that can be performed so that the upper abdomen does not protrude, while the lower abdomen is flat and tight. The surgery you describe involves dividing the belly button stalk from underneath as a means to access the full length of the abdominal muscles for plication, without making an incision around the belly button. The suggested procedure is not a true “float” in the strict sense of the word, because the belly button is re-attached to the base of the stalk from which it was divided and its vertical position is not changed.
In a true “umbilical float” procedure, the stalk of the belly button is cut from underneath and the belly button remains in continuity with the surrounding skin, which now nourishes it. When the skin is pulled downward to tighten it, the belly button ‘floats’ along with the skin and its new position is now lower than what it was pre-operatively. The belly button is subsequently lowered by the amount of tightening produced in the upper abdomen, and its vertical movement is similar in length to the amount of lower abdominal skin removed. It would be rare for this need to occur, but once the belly button has been ‘floated’, a traditional full tummy tuck cannot be performed without significant risk of umbilical necrosis.
There are very few patients in which the belly button can be floated successfully. These are usually patients that have a high belly button position, minimal skin excess, but need a full length muscle plication. If an umbilical float procedure is performed on a person with too much skin excess, the new position of the belly button will be too low after skin tightening, and this will look abnormal. It is best to re-attach the stalk of the belly button to the abdominal wall to anchor it in place and prevent later deformity.
Tummy Tuck and belly button management
There are compromises associated with each type of tummy tuck and you will need to decide what's most important and what isn't. Determining which procedure is the right one for you is complex and is based on your anatomy and what you would be willing to accept. A very thorough discussion between you and your plastic surgeon should help clarify all the important points.
There is nothing wrong or bad about floating the umbilicus. There are two main indications for it. The first is muscle laxity in the upper abdomen in a woman who doesn't have significant excess skin above the belly button. The second is in women with minimal upper abdominal excess skin, upper abdominal muscle laxity, and a high positioned belly button (less common). In either case, the stalk is sewn down to the reconstructed muscle wall in the same position as before or slightly lower, and looks completely normal. Remember, the stalk is just a scar to begin with, and that is what you are left with after the reattachment.
An alternative solution to the first case is a traditional abdominoplasty, but a vertical scar will be necessary to close the defect in the skin from where the belly button was once attached. An alternative solution to the second case is a modified abdominoplasty where the belly button is neither floated nor cut from the surrounding abdominal skin. Repair of the muscle laxity is done directly (and with some difficulty) by going around the attached belly button with long instruments or endoscopically.
Best of luck!
Floating belly button technique
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Full vs floating abdominoplasty
Using a small incision in the lower abdomen, this new tummy tuck surgery technique allows the tummy to be tightened and shaped with optimal results. Also referred to as an extended mini abdominoplasty, this procedure is an excellent option without the telltale signs as there is no incision around the belly button. Excess skin is removed through the incision; the belly button is temporarily detached and ‘floats’ above the muscles. This allows the muscles to become tightened and reshaped from sternum to pubic area, that is, along the entire length of the abdomen, as opposed to a typical mini tummy tuck where the muscles are only tightened below the belly button. The skin on the abdomen is then made smooth and firm, and the belly button is reattached from the inside with the option of moving it down one or two cm if necessary. To sculpt to an even greater degree, liposuction is performed, resulting in beautiful tight abs with a scar that is minimal and discreet.
Please see an experienced board certified plastic surgeon for a physical examination to determine which treatment would be most suitable. Good luck.
Your doc is right. He/she is giving good advice. Listen to them and they will have you on the right track. The only issue is if you want the navel to have a certain shape and you should express this desire to the surgeon so they can create the shape you want if in reason.
Both techniques work depending
Standard tt: incision around bb leaving a hole in the skin. This gives access to the muscle for tightening. The skin is pulled down far enough to remove the part with the hole. If can't get the hole out, it will be sewed, leaving a small vertical scar. This is the most common tt.
Altered tt: TT incision is made, lifting skin up to bb. The stalk is divided allowing access to the muscles for tightening. The skin is pulled down and the bb stalk is attached to the muscle at it new and lower location. This works if there is not much skin to be removed. Can't do it if the bb is moved too low which gives abnormal appearance. BB must be a certain distance from the peak of the vagina.
Standard Tummy Tuck vs. Umbilical Float Tummy Tuck
I really enjoy doing both of these procedures but they are mutually exclusive in who is a candidate. The standard tummy tuck patient has a pannus, or overhanging skin/fat that is significant enough such that the top incision will be made at the top of the belly button. The muscles can be sutured in the midline allowing for tightening and a new opening is made in the pulled down skin for the belly button to be resutured to.
I find that the umbilical float tummy tuck is ideal for women who have very little pannus but primarily have a weak abdominal wall that needs to be sutured. In addition the belly button must be situated, at least at if not ideally, above the level of the iliac crests (hip bones) and is not going to be moved more that 5cm. If it is the belly button can look too low and therefore make the abdomen look odd.
By leaving the umbilicus attached then pulling down the skin below it excess skin will gather around the top of umbilicus and be unsightly. Reattaching the umbilicus is not a problem.
A floating belly button
From the number of responses your question has attracted you can tell that this is an interesting technical point.
In brief there are some limited indications for leaving a floating belly button. It does reattach quite rapidly. But personally I do not like the idea as, as a surgeon I won't have a precise control about where the belly button is going to re-attach. If it sticks to a wrong place (not in the midline or too high or low) it can spoil the result of an otherwise nice tummy tuck.
Tummy Tuck versus a Mini-Tummy Tuck
What you are really asking about is a mini-tummy tuck versus a full tummy tuck.
The full tummy tuck is ideal for excess skin above and below the belly button, excess fat and stretched out muscles. In order to remove the excess skin above the belly button, the skin around the belly button is cut, the belly button stays where it always was and the skin is pulled down toward the pubic area like a window shade - excess skin is removed and the belly button inserts in the skin, by making a small whole in it.
A Mini-tummy tuck is ideal for patients with small or no excess skin above the belly button. In this case the belly button is not touched but in order to get to the muscles above the belly button for tightening, we need to cseparate the belly button from its attachments to the abdomenal muscles. This is called an umbilical float. As long as the button does not move up or down, thinks work great. But if we try to lower the belly button position to remove excess skin, it starts to look a little weird.
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.