Innie or outie? How about neither?

There are lots of people who have surgery at birth or later in life that mean they have no belly button at all.

If you’re one of the few and proud who don’t have a belly button, you aren’t alone.

Keep reading to find out how belly buttons form, why you may not have a belly button, and how you can have surgery to create one if you desire.

The belly button is the remnant of the body’s umbilical cord. An umbilical cord is vital to a baby’s development because it contains blood vessels that transmit oxygen-rich blood from mother to baby and deliver oxygen-poor blood back to the mother.

When a baby is born, a person cuts the umbilical cord. The remaining portion of the umbilical cord leaves a small “stump.”

In about 1 to 2 weeks after a baby is born, the umbilical cord stump falls off. What’s left is the belly button. It’s essentially a scarred area of skin that still has blood flow and some tendons connected to it — which may explain why it’s so sensitive if you touch it.

Some people don’t have a belly button, and the reason for this may be related to surgical history or just an anomaly in how the belly button formed (or didn’t, for that matter).

Most of the time, if you don’t have a belly button, it’s related to a surgery or a medical condition you had when you were younger.

Conditions at birth that may cause you to not have a belly button

Here are examples of conditions you could have had at birth that may mean you don’t have a belly button:

  • Bladder exstrophy. This is a rare condition. It can cause a person’s bladder to be exposed outside the abdomen. This requires surgery because it affects a baby’s ability to store urine.
  • Cloacal exstrophy. This is when a baby’s bladder and a portion of their intestines don’t form properly and are present outside the body. This condition is very rare. It usually requires surgical repair.
  • Gastroschisis. This condition causes a baby’s bowel to push through a hole in the abdominal wall. According to Cincinnati Children’s Hospital, an estimated 1 in 2,000 children are born with gastroschisis. Surgery can correct it.
  • Omphalocele. An omphalocele is when a baby’s intestines, liver, or other abdominal organs are present through a defect in the abdominal wall. The organs are covered in a thin sac. The Centers for Disease Control and Prevention (CDC) estimates 1 in every 4,200 babies are born with omphalocele in the United States.

Surgical procedures later in life that may leave you without a belly button

Here are some examples of surgical procedures that may cause you to lose your belly button. In some cases, you’ll still have an indentation where the belly button once was:

  • Abdominoplasty. Also known as a tummy tuck, an abdominoplasty is a procedure that removes excess fat from the abdomen. The procedure also helps tighten previously weakened stomach muscles to smooth the stomach’s appearance.
  • Breast reconstruction using abdominal tissues. Some breast reconstructive procedures (such as following a mastectomy) involve taking muscles and tissue from the stomach to reconstruct the breast.
  • Laparotomy. A laparotomy is a surgical procedure that involves making an incision into the abdominal wall. This procedure type is often performed in an emergency setting when a surgeon knows something is wrong with the stomach but is uncertain of the underlying cause.
  • Umbilical hernia repair. An umbilical hernia occurs when a person has a weakness in the area in or around their belly button. The weakness allows intestines to push through, which can lead to problems with blood flow if left untreated.

Doctors can perform a surgical procedure to create a belly button. They call this procedure neoumbilicoplasty.

A procedure to improve the appearance of or reconstruct the belly button is an umbilicoplasty.

Some people choose to have a belly button procedure after pregnancy, abdominal surgery, or liposuction. These can change the appearance of your belly button, making it appear more horizontal than vertical.

Doctors can take several approaches to create a new belly button if you don’t have one. Most of these involve creating thin “flaps” of skin that are brought together by a suture or surgical tie, which a doctor sews to deeper layers of skin known as the fascia. This can give the effect that a person has a belly button.

Sometimes a doctor can do this procedure under local anesthesia. This means they’ll inject a numbing medication in or around the belly button area. Other times a surgeon may recommend general anesthesia. You’re asleep and unaware during the procedure so you don’t feel any pain.

The cost for a belly button creation or improvement surgery is usually around $2,000, reports Newsweek. This cost may vary based on where you are and how extensive the procedure is.

Lest you think not having a belly button diminishes your looks…

If you don’t have a belly button, you’re in very good company. Supermodel Karolina Kurkova famously doesn’t have one either.

Kurkova had a surgical procedure when she was younger that resulted in the absence of a belly button. Sometimes companies photoshop one on her (but now you’ll know the truth).

While some people find the absence of a belly button a cosmetic concern, you can take comfort in knowing people like Kurkova that take photos for a living do just fine without a belly button.

If you don’t have a belly button but aren’t sure why, you may want to ask a parent or loved one about any medical conditions or surgery you had as a child. This could provide some clue as to why you may not have a belly button.

If you’ve had surgery later in life and don’t have a belly button but want one, you can talk to your doctor about how to create one via a cosmetic procedure.