Picture this: you’ve gotten a tummy tuck, thrilled to reclaim your body post-pregnancy or define your shape after a significant amount of weight loss—only to find that your surgeon has created an artificial-looking belly button. This aspect of an abdominoplasty is a telltale sign of surgery and, in some cases, enough to deter patients from pursuing the procedure altogether.
“Management of the belly button is a critical component of tummy tuck surgery, as it is often the only incision seen by the public,” says Dr. Mark Albert, a board-certified plastic surgeon in New York City. While an abnormal-looking belly button (aka umbilicus) isn’t always entirely avoidable, there are many measures that can be taken before, during, and after surgery that can steer you toward a better one. Here, with the help of board-certified plastic surgeons, we outline everything that happens to a belly button during an abdominoplasty, what creates a weird-looking navel, and how to get a tummy you’re thrilled to show off.
What happens to the belly button during a tummy tuck?
How your surgeon handles your belly button depends on your unique physique. For the most part, providers no longer completely remove the umbilicus, which is generally seen as an outdated method and what caused the abnormal-looking belly buttons of yesteryear. “Only in rare cases where the belly button has an unusual shape, position, or scarring or where there is a significant amount of excess skin would removing it be a better option,” says Dr. Michele Koo, a board-certified plastic surgeon in St. Louis.
A solid example of this is an umbilical hernia. This is caused when there is a weak spot in the abdominal wall and part of your bowel or fatty tissue is able to push through, creating a distorted navel appearance. An umbilical hernia can also restrict the blood supply of the umbilicus, says Dr. Catherine Chang, a board-certified plastic surgeon in Beverly Hills, California. In this case, “it makes sense to remove the old one and create a new belly button at the same time as doing the tummy tuck,” explains Dr. Albert.
During the majority of tummy tucks today, providers will go with one of two options. The first and most common method is to leave the umbilical stalk intact. This is the tissue that creates your belly button—one end is attached to your abdominal muscles, and the other is what you see when you look at your tummy. Your surgeon will leave the stalk alone, then remove the skin around it. “After all the loose skin from the abdomen is removed, skin from the mid and upper abdomen is pulled down and a new hole is made in the skin to deliver one’s own belly button,” says Dr. Albert.
The other option, known as an umbilical float, is performed when your belly button needs to be relocated, which tends to happen when a patient has a minimal amount of excess skin on their upper abdomen but a moderate amount on the lower half. In those cases, the stalk will be detached from the abdominal muscles, pulled down without removing it from the surrounding skin, then reconnected to the muscles.
Keep in mind that if you’re getting just a mini tummy tuck, it’s unlikely that your surgeon will need to address your belly button at all. During these procedures, skin typically is removed only from the lower abdomen.
What makes a weird-looking belly button?
Most bizarre-looking belly buttons are due to two things, says Dr. Koo—the shape and condition of the original umbilicus and the creation of the new “button hole.” “All ‘abnormalities’ may have preexisted, but there was too much excess abdominal skin to even notice,” she points out.
First, we’ll get into the location of the new belly button. If it appears too high, the new incision may have been made in the wrong place, but often, it’s due to the patient’s anatomy, says Dr. Chang. “Some patients naturally have high belly buttons,” she says. “It is important to point this out to the patient prior to surgery.” If the new belly button is too low, it could be that the buttonhole was incorrectly placed there or an umbilical float resulted in a misplaced belly button. “In these instances, it would be better to rehouse the umbilicus and let the patient know they may have a T incision,” says Dr. Chang. (Most tummy tucks will leave an incision near the belly button and a horizontal one that can be hidden with a bikini bottom; some patients get an inverted T, or fleur-de-lis, incision if necessary.)
A poorly placed buttonhole can also cause an off-center navel, but it’s not uncommon for a patient’s belly button to be slightly off center naturally. An askew umbilicus can also occur during the correction of diastasis recti. “One side might be pulled in slightly more than the other, which can result in the belly button being off center,” says Dr. Koo.
Much of this can be avoided when a provider works closely with an assistant; your surgeon can have the assistant hold the excess skin while carefully marking the location for the new incision. Says Dr. Koo, “the midline mark from the center of the xiphoid [cartilage at the lower part of your sternum] to the center of the external labia should align the horizontal midline, and a mark at the anterior superior iliac crease [top of your pelvis] should align the new vertical ‘buttonhole.’”
When it comes to the aesthetics of belly buttons, the unnatural navels you might see are a skinny “coin slot” slit or a large, rounded umbilicus. With the former, the surgeon didn’t remove enough skin to push the belly button through, while the latter is created by too large a hole. “I prefer to use an inverted-V design when creating this hole so that part of the abdominal skin is introduced into the belly button during closure,” says Dr. Albert. “This breaks up the round incision and creates a more natural appearance rather than the large, round, scarred belly button often indicative of a tummy tuck.”
How to get a pretty belly button after a tummy tuck
The key to getting a satisfying surgical result is to pick the right provider, and that means you’ll need to do your homework. Research surgeons who frequently perform tummy tucks and, ideally, specialize in them, then dive into their patient photo galleries. “Make sure to look at many before and after photos of belly buttons and find a surgeon who creates belly buttons that you like,” says Dr. Albert.
Once you’ve narrowed down your list of providers, ask them questions about how they perform their tummy tucks, what techniques they use to create a new belly button, and which one they’d use on you (and why). Then bring them photos of your dream belly button—all three providers we spoke to encouraged this. “It is always helpful to bring in photographs of what you do like and what you don’t like, to help ensure that both surgeon and patient are on the same page,” says Dr. Chang. “It also helps the surgeon to set expectations for the patient if this is not achievable.” Dr. Koo says to keep in mind that the thickness of the tummy skin and length of your umbilical stalk will affect the shape, but it is certainly helpful to bring in a pre-pregnancy photo of your belly button (if applicable and if you have one) to use as a benchmark.
Post-procedure, it is critical to follow your provider’s recovery protocol. “Do not work out prior to your surgeon giving you approval,” says Dr. Chang. Abdominoplasty is major surgery, and straining yourself could have significant consequences for how your muscles heal, let alone your belly button. Keep your hands off the incision until your provider says you can clean it; Dr. Albert recommends using diluted hydrogen peroxide on a cotton swab, then applying a healing ointment. You can also use a silicone gel or tape on your incision to help the incision heal once your surgeon gives you the OK.
Compression garments are a staple of tummy tuck recovery. Your provider will either provide you with one or recommend one to you; it will likely be pretty firm post-procedure. You won’t need anything with added reinforcement at the belly button. Dr. Koo recommends progressing to softer yoga pants at the four- to six-week mark, as they will still offer some hold.
There is one unusual tip circulating on the internet regarding belly button recovery and shaping post-procedure—placing a marble in the umbilicus and taping it in place, periodically, to create a pleasing shape. But our surgeons advise steering clear of this trick. “If the belly button is formed correctly, there should be no need to ‘reshape’ the belly button during healing,” says Dr. Chang. In very rare cases though, it may be helpful—but only if suggested by your surgeon. “The sutures are delicate in this area, and inserting a marble can do more harm than good,” warns Dr. Albert. “In cases where a belly button is healing narrower than a patient or surgeon would want, a marble can be helpful.”
