You only have (thus far) only one answer (actually, a non-answer) because the difficult truth is that your photo clearly shows visible inadequacy of blood supply and likely a dead belly button. This sometimes happens when surgeons operate on smokers, or patients (despite advice otherwise) who expose themselves to nicotine, or even second-hand smoke. Unfortunately, it can also happen (though much more rarely) with excellent surgery on non-smokers, or without any exposure to nicotine. When a complication like this occurs, some patients are really not interested in answers, or how to move forward, but rather someone to blame. And because of this, many surgeons become reflexively defensive.For now, you require continued follow-up by your surgeon to avoid the compromised (or dead) tissue from becoming infected. This means wearing your binder, not disturbing the dressings, but also careful wound care, leaving the sutures in as long as possible to avoid wound separation, systemic antibiotic coverage, and treatment of the area with topical agents designed to reduce the potential of bacterial invasion into adjacent living tissue.With good care and some luck, the healing will scar down to the appearance very much like a real belly button, though it will take some time. Don't blame your surgeon, but work with him/her, and understand perhaps a bit of defensiveness, though honestly this can happen with "perfectly performed" surgery. It is more common with previous umbilical hernias, pervious umbilical incisions (like endoscopic surgery), and also if the muscle repair is a bit tight. But it's usually no one's fault, simply inadequate microcirculation. So don't be too hard on your surgeon and allow yourself adequate time to overcome this setback and avoid further or worse problems. Best wishes! Dr. Tholen
