What Can I Do if my Belly Button "Dies" As a Result of TT with Umbilical Hernia Repair?

First of all, congratulate your surgeon on his or her honesty; this CAN occur in any tummy tuck patient, and is certainly more likely when an umbilical hernia is repaired during tummy tuck.

The opening in the abdominal wall for your umbilicus (and its blood supply) was stretched, allowing abdominal fat, or if large enough, even abdominal contents such as small intestine to herniate (protrude) through this stretched opening. This is the definition of "umbilical hernia." After pregnancy and childbirth, small umbilical hernias present as "outie" belly buttons. Larger hernias can become symptomatic or even dangerous if small intestine becomes trapped and kinked off in a strangulated hernia. Closing this hernia opening to prevent the protrusion is what it takes to return your umbilicus to an "innie," but this can also compromise the circulation to the umbilical skin.

Gray or bluish discoloration indicates circulatory compromise, and can lead to dead umbilical skin. I see all of my tummy tuck patients the next day to check this, and add nitropaste or other considerations to maximize circulation and diminish the risk of dead umbilical skin. But sometimes this occurs despite our best efforts (or if the patient is a smoker or exposed to second-hand smoke--nicotine is a potent vasoconstrictor and can single-handedly kill skin that has marginal circulation).

At 9 days post-op, your umbilcus is likely either dead or alive (not "dying"), since by now the circulation (or lack thereof) has already declared itself. If dead, there is nothing to do but keep the living tissues from becoming infected (antibiotics, careful wound care, and timely follow-up visits) and allow things to heal. Surgical debridement may be necessary if the dead skin becomes infected. You will ultimately develop a scar in this area that in many cases actually resembles a normal umbilicus quite well. In other cases, surgical creation of a "new" umbilicus can be carried out by your surgeon.

If the belly button circulation was compromised at the beginning of your post-op period and is now recovering, keeping the area clean and protected (and perhaps again considering antibiotic coverage to minimize the risk of infection) will allow the tissues to heal as rapidly as possible.

Perhaps your surgeon is "breaking it to you gently" if 9 days is the first time you have been seen post-op. If the belly button is black, dry, and firm, it is not "dying," it is already dead. Read two paragraphs previously. If the skin is dead, it cannot be revived, but all measures should be taken to minimize adjacent tissue loss or infection of skin or muscle repair sutures that could lead to other problems. See your surgeon frequently and follow wound care protocols carefully. This may take a bit longer than you or your surgeon initially planned, but ultimately things work out just fine in the vast majority of cases. Best wishes!

Sometimes the belly button can die as a result of diminished blood supply. Don't panic, your PS can reconstruct a new one for you. For now, just let this heal and you might be amazed at how good it looks. Another scenario could be the belly button is still viable but has slipped beneath the skin and you just can't see it. This would need a revision as well.

Even if the umbilicus dies, there is a good possibility that the resultant scar will end up looking like a belly button anyway. If it turns out that the tissue dies and resultant scar is not an acceptable one, there are options for creating a neo-umbilicus. Just be patient with your surgeon and address the issues as they develop. You might need to complete some dressing changes for a period of time, but will likely be fine in the end. 

Most plastic surgeons use permanent sutures to tighten the abdominal wall, and some of those sutures are immediately adjacent to your new umbilicus. Umbilical stalk skin necrosis means that the barrier between these permanent sutures and the outside world may be breached, creating the possibility of internal suture infection. Antibacterial ointment will not only reduce the likelihood of an infection, but will also promote the healing of the umbilical stalk if some of the stalk is still viable (i.e. it has enough blood flow to survive). The blood flow to the umbilical stalk and the blood flow to the abdominoplasty skin flap are completely different. So umbilical stalk necrosis does not mean you are at high risk for abdominoplasty skin flap necrosis. If the skin of your lower abdomen just above your suprapubic abdominoplasty scar is pink and you are ten to fourteen days postop, then there is no need to worry about skin flap necrosis. The best course of action is local wound care as mentioned above and frequent visits to your plastic surgeon. Regarding the long–term appearance of your new umbilicus: the sutures through the skin adjacent to your bellybutton will create permanent suture marks if they are not removed soon. Ask your surgeon if that can be done in order to avoid a pattern of dot-like scars around your new umbilicus which will make it look like a surgical bellybutton, not a natural belly button. It is possible to place umbilical skin sutures so that they pass through the dermis only (and not the epidermis) on the abdominoplasty skin flap side of the umbilical closure. You may ultimately require some form of revisional surgery once the bellybutton wound has healed, but in most cases a definitive secondary procedure cannot be done for at least 6 months or so. So you will need to be patient, take good care of the wound, and see your doctor frequently as this issue evolves.

Although there is a risk of injury to the unmusical bold supply during tummy tuck with hernia repair, at this point it is too early to determine how much injury. I would suggest you wait till the swelling, subsided and your plastic surgeon will be able to determine if anything needs to be done. In many occasion the umbilicus is dusky and looks like its necrotic after hernia repair,but eventually it recovers or most of it survive.