Abdominoplasty, commonly known as a tummy tuck, is a surgical procedure designed to create a flatter, firmer abdominal contour by removing excess skin and fat and tightening the underlying abdominal wall muscles. Patients often seek this surgery after significant weight loss or pregnancy, which can leave behind loose skin and weakened core structures. Because the procedure extensively reshapes the abdomen, the final appearance and repositioning of the belly button (umbilicus) is a major consideration during a standard, full abdominoplasty.
Umbilical Transposition: The Standard Approach
In a standard full tummy tuck, the umbilicus is not detached from its internal connections. The surgeon makes an incision around the circumference of the navel, separating the abdominal skin from the navel’s outer edges. This releases the belly button from the skin flap while ensuring the umbilical stalk, which connects to the deeper abdominal wall muscles, remains intact and in its original position.
The large skin flap of the upper abdomen is pulled down toward the pubic hairline, allowing the surgeon to remove excess skin and tighten the underlying muscles. Since the original skin location of the umbilicus has been excised, the belly button is hidden beneath the newly repositioned skin flap. A precise, new opening is created in the tightened abdominal skin at the appropriate height for the umbilicus.
The surgeon brings the original, internally connected belly button out through this new opening. This process of releasing the navel and re-suturing it into a new location on the skin flap is known as umbilical transposition. The original navel is sutured to the edges of the new skin opening, which effectively creates a new, natural-looking belly button position on the abdomen.
Achieving an Aesthetic Umbilicus
The repositioning of the umbilicus is a specialized procedure called umbilicoplasty, performed to ensure the final appearance is natural and aesthetically pleasing. Surgeons focus heavily on the shape, depth, and overall size of the new navel to complement the flatter abdomen. A vertical or slightly oval shape is often considered a desirable aesthetic outcome.
To achieve depth and conceal surgical lines, techniques are used to hide the scar within the inner folds of the navel. Methods often involve creating a small skin hood over the top edge of the new opening, which creates a subtle shadow and contributes to a more natural contour. Careful placement of internal sutures helps draw the new belly button inward, avoiding a flat or overly wide appearance.
Limited Procedures Where the Navel is Unaffected
Not every abdominoplasty requires navel transposition. A limited abdominoplasty, or mini-tuck, is an option for patients whose excess skin and laxity are concentrated only below the umbilicus. In these cases, the skin flap is not lifted to the rib cage, and skin removal is limited to the lower abdomen.
Since the surgical work is confined beneath the navel, the umbilicus is typically left untouched, and no incision is made around it. The downward pull of the skin closure may slightly stretch or pull the navel into a lower position, but the navel remains attached to the skin and does not require transposition.
Umbilical Sacrifice
In rare, specialized surgeries for massive weight loss, where the amount of skin to be removed is extensive, the umbilicus may be removed entirely, a process known as umbilical sacrifice. This extreme measure is reserved for complex cases where preserving the original navel is not surgically practical or would yield a poor aesthetic result.