Am I A Good Candidate for An Umbilicoplasty? (Outie to Inne Belly Button Conversion)

Q: Dr. Eppley, I was wondering if you could take a look at the attached photos and see if I am a good candidate for umbilicoplasty to achieve a typical “innie”. I have been told by my general practitioner and another cosmetic surgeon I do not have a hernia (they made me cough and felt around my abdomen) but I can insert more than half my finger into the tunnel of my bellybutton which made me question this? It just feels like it is a VERY long stalk and with excess skin. I do have a little fat around my midriff but when I was younger and very skinny my belly button protruded a lot. I am working on losing the weight but do not want it to protrude again. Please have a look and tell me what you think.

A: When it comes umbilicoplasty surgery, it is important to consider what makes the outie belly button look the way it does. Outie belly buttons can occur by two anatomic mechanisms. The most recognized one is an actual umbilical hernia (Type 1) that causes the entire stalk of the belly button to protrude outward either staying within the umbilical stalk or even protruding beyond the outer skin ring. This type of outie belly button feels very soft and can be pushed all the way beyond the abdominal wall fascia. A ring defect through the fascia can be felt by deep palpation. The other type of outie belly button is not associated with a true hernia (Type 2) and is either due to a long umbilical stalk (probably due to where it was cut at birth) relative to the thickness of the abdominal wall or from a weak or absent attachment of the stalk to the fascia. This type of outie belly button will feel more firm, less distensible and can not be pushed inward beyond the underlying abdominal wall fascia.

Either way the outie belly button can be converted to an innie through an umbilicoplasty procedure. The Type 2 outie belly button is somewhat easier and more reliable to fix since there is not a concomitant fascial defect/hernia to deal with at the same time and thus has a more stable base onto which to attach the inwardly reshaped umbilicus.

Dr. Barry Eplpey

Indianapolis, Indiana