Umbilical Appearance Post Abdominoplasty

What is the umbilicus?

The umbilicus (or belly button) is the scar or remnant of the umbilical cord. The umbilical cord contains the two arteries that delivered oxygen & nutrients and the single vein that removed waste as a baby develops within the mother’s uterus.

What does a normal umbilicus look like?

Specialist Plastic Surgeons view an umbilicus like a wine glass – it has a stem and a cup. There are many variations naturally, and things change with pregnancy and weight changes. In thin individuals who have never been pregnant or had massive weight fluctuations, the stem is very short and the cross section is more like an ice cream cone. With weight gain the stem and cup can elongate and the cross section will look more like a champagne flute. Some patients have a very flat umbilicus and their cross section is more like a cereal bowl or even a dinner plate!

Some people talk about having an “innie” or an “outie”. An “outie” is almost always an umbilical or paraumbilical hernia or weakness in the abdominal wall around where the umbilical scar is continuous with another scar/ligament within the abdomen.

Where should the umbilicus be situated on the abdominal wall?

Anatomy textbooks describe the umbilicus as being situated at the level of the third lumbar vertebra or at the L3/L4 intervertebral disc. Specialist Plastic Surgeons will usually try to site the umbilicus at about the height of the iliac crests (top of your hip bones on the sides). There is some discussion amongst Specialist Plastic Surgeons of the relative ratio along the abdominal wall that it should sit – with a ratio of 1 below, and 1.6 above (Phi or Golden ratio). The umbilicus is just a scar and can be positioned imperfectly just where nature placed it. In about 5% people, the umbilicus is naturally not even in the midline!!

Your surgeon can tilt your umbilicus up & down and to the sides to some extent to bring a belly button back to a more normal or standard position. It is very difficult to move a belly button a long way without killing it. Circumstances like this are best managed with a planned umbilical reconstruction.

What scar pattern is used for umbilical inset?

There are many variations of umbilical inset scars, which means that none of them are perfect. All patterns work great sometimes and look rubbish at others. This is not entirely predictable pre-operatively. Dr Gavin Sandercoe prefers a frown shape inset or scar, as it creates a hood above the umbilicus and a lower ramp. An upside-down triangle creates a similar final umbilical shape. A tight vertical oval can look good in athletic abdomens but is not a great choice for heavier patients. The circle (or button) inset is a last choice in standard abdominoplasties in Dr Sandercoe’s opinion, but it is the only option when in-setting an umbilicus in a Fleur De Lys or Corset abdominoplasty.

What will my umbilicus look like after an abdominoplasty?

The final look of your umbilicus after an abdominoplasty depends on what you start with – your pre-operative umbilical shape and thickness of the abdominal wall fat. Patients that start with a flat dinner plate style umbilicus and thin abdominal wall fat will not be able to have a deep umbilicus. Your Specialist Plastic Surgeon has the skills to shorten an umbilical stem and has some control over the depth of the cup/bowl of your umbilicus. The more that a Specialist Plastic Surgeon needs to adjust an umbilical shape, the greater the risk of problems healing or umbilical necrosis. A quick perusal of the clinical photographs in this abdominoplasty section & gallery will show the variation in final umbilical appearance from a single surgeon.

If you are in Sydney and considering an abdominoplasty, we invite you to use the form below to contact the team at Dr Gavin Sandercoe Specialist Plastic Surgeon. As always, all surgical procedures have some risk and you should consider a second opinion from another Specialist Plastic Surgeon in Sydney.