Abdominoplasty, commonly known as a tummy tuck, is a surgical procedure designed to tighten the underlying abdominal wall muscles and remove excess skin and fat from the midsection. While the primary focus is on achieving a flatter, firmer abdominal contour, the belly button, or umbilicus, is a central landmark requiring specific surgical management. The appearance and position of the umbilicus are crucial to the overall aesthetic outcome of the procedure. For a full abdominoplasty, the necessity of skin removal and redraping means the umbilicus must be carefully preserved and repositioned.
The Process of Creating a New Belly Button
The standard approach in a full tummy tuck is umbilical transposition. The original belly button is not detached from its connection to the abdominal wall muscles, known as the umbilical stalk. Instead, a circular incision is made around the umbilicus to separate it from the surrounding skin that will be removed.
The skin flap of the abdomen, now freed from the belly button, is pulled downward to the lower incision line, and the excess tissue is excised. This tightens the abdominal skin surface, covering the original site of the umbilicus with the repositioned skin flap. The umbilical stalk remains anchored deep within its original position on the underlying muscle layer.
To allow the umbilicus to emerge through the newly tightened skin, the surgeon locates the preserved umbilical stalk beneath the skin flap. A new opening, or stoma, is created in the abdominal skin at the correct position, typically determined by aesthetic guidelines based on body proportion. The original belly button is then pulled through this new opening and sutured precisely into the edges of the surrounding skin. This process repositions the umbilicus to a location appropriate for the new contour.
Achieving a Natural-Looking Umbilicus
The aesthetic quality of the umbilicus is considered a marker of a successful abdominoplasty, and surgeons employ specific techniques to avoid an unnatural, circular, or “plugged” look. A naturally appearing umbilicus generally has a vertically oriented, oval shape with a slight indentation and superior hooding.
To achieve this, the opening created in the skin flap is often shaped like a vertical slit, an inverted “V,” or an inverted “U,” rather than a simple circle. This shaping encourages a more elongated final scar pattern and helps the umbilicus look recessed. Surgeons also often thin the fat tissue around the site of the new opening to create a natural concavity around the belly button.
The process of securing the umbilical stalk to the edges of the new skin opening is performed with careful suturing. This technique helps to anchor the umbilicus deep enough to create the desired shadow and depth, contributing to the hooded appearance that mimics an untouched navel. The goal is a seamless transition between the umbilicus and the surrounding abdominal skin that minimizes the visibility of the internal scar.
Caring for the Umbilicus During Recovery
Post-operative care for the umbilicus is important for proper healing and to minimize the risk of complications. Immediately after surgery, the area may appear swollen or bruised, and some crusting is common as the new incision site heals. Patients are instructed to keep the area clean and dry, which is essential because the natural indentation of the umbilicus can easily trap moisture and bacteria.
Cleaning instructions often involve gently washing with mild soap and water or a saline solution, then patting the area completely dry. Maintaining a dry environment is important to prevent infection and avoid delayed wound healing. Surgeons advise against submerging the area in water, meaning baths, pools, and hot tubs must be avoided for several weeks, often six or more.
Signs of normal healing include a gradual reduction in swelling and redness over the first few weeks. Patients should monitor the site for persistent discharge, increasing pain, or excessive redness, which could signal an infection and require immediate medical attention. While the initial healing of the skin incision takes a few weeks, the final appearance of the umbilicus may take up to six months as the scar tissue matures and softens.
When the Belly Button Isn’t Moved
Not every abdominoplasty procedure requires umbilical transposition. In cases where excess skin and fat are concentrated primarily in the lower abdomen, a “mini tummy tuck” may be an option. This procedure involves a shorter horizontal incision made low on the abdomen, and skin removal is limited to the area below the navel.
Because the surgical work is confined to the lower abdominal region, the skin flap above the umbilicus is not significantly lifted or tightened. As a result, the belly button remains in its original position and is not released from the surrounding skin. This avoids the need for an incision around the umbilicus and the subsequent creation of a new opening.
While a mini tummy tuck may slightly pull the umbilicus downward due to the tension created by tightening the lower abdominal skin, it largely preserves the umbilicus in its natural state. This approach is only suitable for patients with mild to moderate skin laxity and minimal excess tissue above the naval. Procedures that involve extensive skin removal, such as full or extended abdominoplasties, necessitate umbilical transposition to ensure a flat, contoured result.