Of the many structures of the body which differ in appearance, the umbilicus or “belly button” is the most variable. The umbilicus is the remnant of the umbilical cord and is tied off at birth. it slowly contracts into the abdominal wall over the next few months of life. In most people, its appearance is a non-issue.
There are conditions which can cause the umbilicus to appear abnormal. The most common cause is a congenital umbilical hernia. This is caused by a weakness in the abdominal wall resulting in protrusion of the belly button, which in many cases is referred to as an “outy”. The skin in the umbilicus is stretched so that not only is the hernia repaired but a skin reduction is performed so to create a normal appearing “inny”. A plastic surgeon who has also trained in general surgery is better equipped to perform this surgery to create an umbilicus which is both structurally sound and aesthetically pleasing.
A similar umbilical deformity may occur after pregnancy, weight gain and certain surgeries. The abnormal appearance is similar but usually slightly more pronounced. The hernia repair may require more intensive work with or without the use of a supporting mesh. The priority is to repair the hernia so that it does not recur and provide the best cosmetic result possible.
There is a group or patients who have undergone previous cosmetic surgery, specifically a tummy tuck operation which has resulted in a significant umbilical deformity. This may have been the result of infection, poor healing post operatively or simply poor technique by the plastic surgeon. The appearance of the belly button can be so abnormal that the patient cannot wear a two piece bathing suit because of the embarrassment of the shape and size of the umbilicus. If the belly button is too large, this is a relatively easy repair. On the other hand, a very small contracted umbilicus requires an entirely new approach, possibly using a skin graft to reconstruct and recreate a belly button.
Whatever the situation, consulting an experience board certified plastic surgeon is your best bet to having a normal appearing umbilicus.