Tummy Tucks: What if You Have Already Had Operations on your Belly Button?

It's not uncommon that patients ask me what I do with the belly button during an abdominoplasty (also known as a tummy tuck).  The short answer is...

• I preserve the belly button that your mother gave to you.
• After I tighten the skin and muscles of the abdominal wall, I make a new hole for the belly button, and I suture the belly button into its new position.

This technique works because the belly button has a dual blood supply....

• from the surrounding skin
• from its "stalk"

When I perform an abdominoplasty, obviously I disrupt the blood supply from the surrounding skin.  However, I preserve the blood vessels from the stalk.  Hence, with at least one good blood supply, the belly button continues to have good nutrition, and so it heals without incident.

What happens in the patient who requests a tummy tuck but whose umbilical stalk has probably been disrupted?  Here is a recent question from one of my patients...

My question is about my umbilicus. I had a lap chole [a laparoscopic cholecystectomy, which is the removal of the gall bladder through tiny incisions with the aid of a small video camera].  And I have had an umbilical hernia repair. (The hernia was quite big from 3 pregnancies).  Due to that, I have no umbilical stalk--no blood supply to the umbilicus.  How would you go about creating a belly button during my tummy tuck?  Is it possible to "create" an authentic looking belly button during the tummy tuck procedure?  Or does it have to be done at a later date?

Difficult, huh?  What should I do?

First, she should be congratulated for having survived three pregnancies, a laparoscopic cholecystectomy, and an umbilical hernia repair!

Second, she needs to be warned that, since the belly button has no stalk (from the laparoscopic surgery and the hernia repair), the umbilicus could be starved for nutrition, and then could die.

However, I have had success in similar circumstances by replacing the bellybutton as a skin graft. This means that I totally detach the bellybutton, thin it of any fat, and then stich it back into an artificial hole.  The skin of the bellybutton then "grafts" itself back to the abdomen.  It gets its nutrtion by "stealing" it from the surrounding tissues.  This is possible only because it is so thin.

(By the way, skin graft surgeries are very common.  Skin grafts are what I normally do when I help patients with burn reconstruction or skin cancer reconstruction.)

To be honest, skin grafts are alway a bit risky.  What if the skin graft can't "steal" enough blood and nutrition?  Well, then the skin graft dies, and the patient is left with a wound.

In the case of a dead bellybutton after a tummy tuck, the resultant hole must heal from the bottom up.  But don't fret!  A belly button is nothing but a scar created by the in utero attachment to a person's mother!  So, the scarred-up, healed-from-the-bottom-up, neo-belly button can frequently look pretty authentic.  If it doesn't, I still have other tricks up my sleeve (such as other types of skin grafts and such as stretching techniques).

Let's keep our fingers crossed for this patient!

Comments

[Patti]

I have an umbilicus hernia and diastasis recti and would like to have them repaired at the same time. Several years ago I had exploratory laparoscopic surgery through my belly button to check my ovaries and uterus. I was not told (or never heard of) not having an umbilical stalk after this procedure. What are the chances of "belly button death" as a result of my diastasis and hernia repair? Thanks.

[Michael Pickart]

Dear Patti,

During your tummy tuck, a Board Certified Plastic Surgeon will repair your diastasis recti, and can easily repair your umbilical hernia too.

I think that it would be extremely unlikely that your "umbilical stalk" was damaged during your laparascopic surgery. So, your belly button will probably do just fine after an abdominoplasty.

Obviously, you should mention your laparoscopy and umbilical hernia to your surgeon before any plastic surgery, so that he/she can adjust his/her plan accordingly.

Best wishes!
Mike Pickart

[laser hair removal rancho cucamonga]

Thank you for the techniques i will apply those tips for my belly button operation for sure.

by: sphin

[tummy tuck]

Wow, I honestly didn't know about this. I remember seeing a photo of Lindsey Lohan and of how her belly button has gone up to the bottom of her rib cage. The plastic surgeon must have neglected that.

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