Your Questions
Your Questions
Q: Dr. Eppley, I am interested in umbilicoplasty surgery. (technicaIly umbilical scar revision after a tummy tuck) I just recently had a tummy tuck 6 weeks ago and my belly button is off to the left a little… I want to correct this but I wasn’t sure how long to wait? And if this is something you can do?
A: If you have had a fully tummy tuck and your belly button is off midline, it can be moved back closer to the midline through an umbilicoplasty procedure. But there may or or may not be a residual scar out of the ring of the belly button scar based on how far it needs to me moved over. I would need to see pictures of your abdomen to better answer your question. Most likely when you say a little I would imagine it is probably no more than 1 to 1.5 cms at most. It is possible that just excising a crescent of skin towards the midline on one side of the bellybutton may be the type of umbilicoplasty (umbilical scar revision) that you would need. I would certainly vote for that approach even if it can’t be gotten completely to the midline because to will keep the scar confined to the circumferential existing scar around the belly button.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in umbilicoplasty surgery. My belly button has been this way for about 10 years, ever since the birth of my son. It has been the source of my insecurity and I am so self-conscious about it that I can’t even wear a fitted shirt because it clings to my belly button and creates this weird looking indent. I hate it and fixing it would make me so incredibly relieved and ecstatic. I can’t afford a tummy tuck and even so I would hate to go thru all that just to fix one little thing. I really sincerely hope something can be done.
A: Quite frankly, your belly button concerns are due to the excessive surrounding tissues that are collapsing around it and engulfing it. This is not a belly button problem per se, it is due to excessive abdominal skin and fat. Thus there is no umbilicoplasty surgery that is going to correct it nor would it even be wise to spend any money trying it as it will not solve your concerns. What you need is a fully tummy tuck which will treat the real source of the belly button problem by removing all the excessive tissue and in the process create a new belly button. While you may not be able to afford it now, it is much better that you wait until the day you can and then have the correct operation. That is a far better financial decision as an umbilicoplasty surgery now would be a disappointment and waste of money.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a large outie belly button that appeared after a prior abdominal surgery about ten years ago. Having had two children afterwards the size of the outie is increasing. Besides the outie, my belly button is way too wide and looks like a ‘sombrero’ to think of the closest analogy that I can. I have attached a picture for your assessment as to how fix this saucer-sized outie belly button. I absolutely hate it!
A: Thank you for your inquiry and sending your picture. Your large outie is likely the result of an umbilical hernia from your original abdominal surgery. (noting the midline abdominal scar above and below the umbilicus) Your belly button repair (umbilicoplasty) would require a combination of correcting the hernia and simultaneously converting the outie into an innie umbilical shape. This can usually be done successfully, particularly when one has the ‘advantage’ of being able to use some of the abdominal scar above and below the belly button. But the key is to repair the hernia which is pushing out on the belly button thus creating its outie appearance. The outie skin can then be tacked back down to the abdominal fascia, recreating an innie funnel look.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a tummy tuck eight months ago and, although I am happy with most of the results, my belly button afterward has always looked a little funny to me. It looks bloated for lack of a better medical description and bigger than it did before the tummy tuck. It was not a great looking belly button before the surgery but it looks no better now and even looks a little deformed. Can you tell me what is going on and how I can fix it?
A: A ‘bloated’ belly button after a tummy tuck suggests that too much of the umbilical skin is seen on the outside. This usually results from an umbilical stalk that is too long for the thickness of the tissue between the skin and the abdominal wall, pooching outward creating a mushroom or bloated appearance. An umbilicoplasty procedure can be done to shorten the stalk and pull the belly button back inward for an unbloated or more of a funnel effect to create a more natural belly button appearance.
While the creation of the ‘new’ belly button in a tummy tuck is the most minor part of a tummy tuck, it along with the scar line is the most heavily seen feature of the result. Shortening the umbilical stalk, keeping the new opening in the skin small, and removing a funnel of fat between the skin and the abdominal wall all help to create an inward shape or pull to the recreated belly button and allows the scar line to be situated in a more obscure location.
Dr. Barry Eppley
Indianapolis, Indiana
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
Q: Dr. Eppley, I am interested in belly button reshaping and it seems like you have done this surgery. Since most doctors said they can not do anything I am not sure if it is the stitching that is the problem or under the stitching. I removed my gallbladder last year, since then it has not been the same. I had a beautiful innie and now I am somewhat outie and it has been emotionally upsetting for me. I do not want to have any noticeable scars after doing the procedure or to make matter worse. I just want to make sure it will look the same as before. Please let me know how is it done and where is the scar hidden. Thank you so much for your understanding and your time.
A: Most cases of belly button reshaping is done to change outies to innies. Outie belly buttons may occur naturally or as a result of a surgical procedure as in your case. Your gall bladder was most likely removed by a laparoscopic technique of which one port was done through the belly button. Given that an innie belly button is nothing more than skin tethered down to the abdominal wall fascia, the insertion of the laparoscope disrupted this funnel-shaped attachment and now the belly button skin is just floating so to speak. Thus your innie became a partial outie now. Your belly button can be repaired by reattaching it back down to the abdominal fascia through an incision inside the belly button. This rsults in no scar on the outside. This can be done under local or light IV sedation anesthesia. I have performed this procedure numerous times for exactly the problem you now have.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a woman who is interested in umbilicoplasty. I have attached one photo which is similar to how my bellybutton looks. I am not certain if it is a hernia as I have had this my entire life. I am wondering how if an umbilicoplasty procedure could successfully change my outie bellybutton into an innie bellybutton, even if it is not a hernia.
A: The umbilicoplasty procedure involves a variety of small procedure to reshape the belly button or umbilicus. It can be done t change an outie to an innie as you desire or to remake an umbilicus lost from prior surgeries. An outie belly button may or may not represent an actual hernia. If you stick your finger and push the outie in…and feel an inner ring or hole and the outie pushes into an innie…then it is a hernia. If you push on it and the outie simply gets flattened but does not push in, then it is not a hernia, it is just a ‘button of skin’ so to speak. It is not possible to answer that question by just looking at your picture but I suspect, given your young age and perhaps not having children (??) that your outie is not a true hernia. Eitehr way, an umbilicoplasty can convert an outie into an innie whether it is a hernia or not, just some slightly different techniques are used to do it. An umbilicoplasty can be done under just local and, at the most, some IV sedation as a simple outpatient procedure. There is no real recovery from it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in an umbilicoplasty procedure. I hate the look of my bellybutton as it sticks out and want a prettier bellybutton that turns in like most people. How is the procedure done and was is the approximate cost of turning an ‘outie’ into an ‘innie’. Thank you.
A: The bellybutton or umbilicus is the residual attachment of the umbilical cord. It forms a visible depression in a very constant and central location on the abdomen. Underneath it lies the midline union of the paired vertical rectus muscles which will also have a depression or concavity in it, making it a structural point of potential weakness and the potential for a hernia. Most commonly the navel appears as a depression or innie which occurs in about 90% of people. In the minority (10%) an outie belly button is present which can either just be from extra skin left over from the umbilical cord or exists because the skin at the base of the belly button is pushed outward from a protruding hernia.
Differentiating the type of outie bellybutton is important as that determines how it is done and the cost of the surgical techniques to do it. An outie that is just a stump of skin (no hernia) can be done in the office under local anesthesia. The stump of skin is removed and the edges sewn down to create the innie look at a cost of $1500. If the outie has a palpable hernia, it will need to be repaired in the outpatient operating room under IV sedation. The umbilical hernia needs to be repaired at the same time with a total cost of between $2500 to $3000.
How do you know if your outie has a hernia? Push inward and see if you can feel a ring or hole underneath. Also an outie that is just a stump of skin can not be displaced inward. (the stump gets pushed in but the stump keeps its shape) The outie that can easily be pushed inward through the inner ring or hole has a hernia.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I just need info on getting my belly button repaired. I don’t need a tummy tuck, literally just need my belly button put back after it “popped” during my pregnancy.
A: What has undoubtably happened is that you have developed an umbilical hernia as a result of your pregnancy. This has changed your belly button from an inne to an outie. The attachment of the belly button to the abdominal wall is an inherently weak point along the midline attachment of the vertically-oriented rectus muscles and their enveloping fascia. The enlarging fetus during pregnancy puts a lot of pressure directly behind the umbilicus. For some women this results in the area around the base of the umbilicus to separate. This results in the base of the belly button coming away from the abdominal wall and some intraperitoneal fat protruding outward. This push of tissue from underneath creates the change from an innie to an outie. You can probably push your outer in and feel a small hole underneath it. This can be repaired through an umbilicoplasty procedure, closing off the hole and re-attaching the umbilical stalk back down to the abdominal wall.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi I am 18 yrs old and I have been insecure about my body for quite some time now. At the time I was born to the present I have been very depressed because I have a huge navel. (outie). I really find it hard to wear clothes without thinking about my navel. For example, If they are going to see it, what will their reaction be, etc. I am tired of being unable to wear bathing suites and clothes and I need a solution. Today was the first time i heard that there was a surgery called Umbilicoplasty that can change an outie into an inne. I need help. I am wanting to know what can be done.
A: The belly button or umbilicus is really nothing but a scar that extends from the skin down to the abdominal wall. Originally it was where the umbilical cord extended through the abdominal wall. Thus it really represents a small hole or defect in the abdominal wall. In most people, that scar is inverted or v-shaped and is an inne. In the minority of people it can be an outie because a small amount of peritoneal fat protrudes through the abdominal wall pushing the scar outward making an outie. In essence being a small abdominal wall hernia. Some outies are just everted scar but bigger ones are actual small hernias. Either way, an outie can be fixed by changing the scar to attach directly down to the abdominal wall or fixing the hernia. This is known as an umbilicoplasty and changing an outie to an innie is the most common non-tummy tuck form of it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I want to get my outie turned into an inne bellybutton. I don’t care for how it looks now, I think it looks weird. I have always wanted to get it fixed so I could look like everyone else. Can you tell me about how this is done and what is involved?
A: Belly buttons are nothing more the formation of scar and is actually the body’s first scar. The umbilical cord, which supplied precious nutrients to the unborn baby, is clamped off shortly after birth. It is clamped off an inch or two from where it exits from the baby’s stomach and the placenta and much of the cord is removed. The remaining stalk of the umbilical cord goes on to die and fall off, leaving a small scar we know as the belly button. For most people (90%), the scar is concave and is an innie. For the remaining 10%, the scar tissue protrudes slightly from the body creating an outie.
An outie can be changed to an innie with an umbilicoplasty procedure. This is a small outpatient operation done under IV sedation or local anesthesia. A small incision is made on the inside of the belly button. Scar tissue between the underside of the bellybutton and the abdominal wall is removed. The underside of the outie is then swen down to the abdominal wall, changing its appearance to an innie. Dissolveable sutures are used and the only dressing is a band-aid. One can shower the next day and not worry about getting the area wet. One should avoid strenuous exercise for one week and no sit-ups or crunches for one month after the procedure.
In women who have had children, their outie could be an umbilical hernia particularly if it did not exist prior to pregnancies. This is a common finding during tummy tuck surgery. Since you are a male, your outie is unlikely to be a hernia.
Dr. Barry Eppley
Indianapolis, Indiana
Q : Is umbilicoplasty recommended only after you’re done having children? I heard the procedure could be ruined during pregnancy.
A: As a general rule, changing the shape or form of the umbilicus (belly button) is a simple procedure that is usually permanent. However, pregnancy is well known to affect the umbilicus due to its expanding effects. The usual way it can change the umbilicus is to convert an ‘innie’ to an ‘outie’. This is the result of an actual hernia coming through where the umbilicus attaches to the abdominal muscle wall. One must remember that the umbilicus is really nothing more than a scar that goes all the way through to the underside of the muscle wall to the peritoneum. This can be appreciated during a mini-abdominoplasty where the umbilicus is often released and repositioned lower. Once it is cut off at the level of the abdominal wall, a small hernia is immediately apparent.
Because of the potential negative effects of pregnancy on the umbilicus, one should usually wait until after pregnancy for a female umbilicoplasty procedure. If you are converting an outie to an inner, it is possible with the increased abdominal pressure from pregnancy to have it change back to an outie after surgery. The one exception to this id if one is not planning to get pregnant for years. Adequate healing and scarring will then have occurred and it will be able to better resist stretching forces. But if one thinks it is possible to get pregnant within the first year after repair, then one is better to wait.
There are some umbilical changes that may be not be so adversely affected by pregnancy. Removal of skin tags, small scars, nevi, and a ‘pseudoinnie’ (looks like a partial outie but is just a lump of scar tissue) can be done with a low risk of post-pregnancy change.
Dr. Barry Eppley