Is my Belly Button Too Low?

Question

I am 30 days post op. I did not have a new belly button created, simply pulled down. It was a standard tt with lipo of the stomach, flanks and pubic mound. Muscles were repaired. It still hurts when I sneeze and cough but other than that I feel well I just dont like my belly button so low. I am still wearing a binder. My drains were removed the day after surgery and I still have swelling mostly after sitting and driving. Is this all normal?

Steven M. Lynch, MD · Answer

Hi...I am not sure I understand the circumstances here but it seems that you had a tummy tuck with a W scar in the lower abdomen first. Then, you seem to have another pic showing another tummy tuck but you say that the belly button is too low. Your pic shows a smaller waist and what might have been an excision of the tissue including the W scar an tissue above it with liposuction to give you the better shape. You mention that you had the muscles repaired but the belly button not separated. This would indicate that you had a floated belly button to allow for the excision of the tissue of the lower abdomen and including the old scar. You are only 4 weeks out so you cannot make any determination concerning your results right now but you should ask your ps what might have made your belly button seem too low. If floated, then by definition, it will be lower. If too low for you and you are far enough out from your procedure, then you need to discuss your options with your ps. Be patient. Your changes certainly look pretty good for only 4 weeks and it will get better.

Tom J. Pousti, MD · Answer

Thank you for the question and picture.

	At 30 days It is too early to evaluate the appearance of your abdomen;  I would suggest you wait as close as possible to one year before making a final &ldquo;judgment&rdquo;.

	Abdominal wall "swelling" after tummy tuck may be related to:

	1. Swelling in the soft tissues.  This may take several months to resolve and may worsen with increased activity  or at the end of the day.   Patience  is required to allow for resolution of the swelling. The swelling occurs because of the interruption of venous and lymphatic channels that occurs during the tummy tuck operation.
	2. Fluid accumulation in the space between the skin and the abdominal wall muscle.  this may consist of blood ( hematoma)  or serum (seroma).  This fluid accumulation can generally be diagnosed by physical examination ( occasionally ultrasound  may be helpful).  Treatment consists of aspiration;  several episodes of aspiration may be necessary. 
	3. Separation of the abdominal wall muscle repair may lead to a swelling/bulge appearance. This may be diagnosed on physical examination  with your surgeon examining you in different bodily positions. One of the steps of a tummy tuck procedure involves reapproximation (plication)  of the rectus muscles.  These muscles have spread apart during pregnancy and/or weight gain. Bringing them together again in the midline helps to &ldquo;tighten&rdquo; the abdominal wall as well as to narrow the waistline.
	4. Residual adipose tissue may be confused for swelling. Again this is most easily diagnosed by physical examination. Additional liposuction surgery maybe necessary to improve the results of surgery.
	Generally, it takes many months for swelling to resolve after tummy tuck surgery and it may take up to one year  (or greater)  a complete skin redraping  to occur.

	I hope this helps.

Michael D. Cohen, MD · Answer

This is a matter of opinion. If you don&rsquo;t like it, it may be too low. The umbilicus (belly button) is usually at the level of the anterior iliac crest (hip bones) and should &ldquo;look&rdquo; normal to you. If a modified tummy tuck was performed it might have been &ldquo;floated&rdquo; into that position and may seem off. Converting to a full tummy tuck might solve this problem. It is best to discuss this with your surgeon to find the best option for you.

Alan M. Engler, MD, FACS (retired) · Answer

Maybe - but the questions are (1) why and (2) what can you reasonably do about it at this time?

	First of all, it is too early to tell.  It takes at least several months for things to "settle" after this much surgery and I would not be comfortable making a statement on what the final position and result will be.

	Secondly, though, you say that you did not have a new BB created - so was this one pulled down ("floated") or is it just stretched from a mini or moderate TT?  If you had the skin lifted up all the way to the ribs, then your BB may, indeed, wind up lower than it was (that's the result of "floating" the BB).  If it was just the lower portion that was pulled down, then most of that lower position will return to its normal position once the swelling subsides and the skin stretches out.

	So you should ask your PS exactly which procedure was done and then try to make a determination what, if anything, you can do about the location of your BB.  I suspect that there won't be too many options - but it's hard for me to say via this forum.

	I hope that this helps, and good luck,

	Dr. E

Richard Linderman, MD (retired) · Answer

As you are only four weeks post op surgery, it is difficult to predict your final belly button location. Your incision is a little higher giving the appearance of a low belly button. I would ask you to be patient for six months and then take another look.

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