They put a peg around an inch away from the belly and another peg about two inches away. Then cut between the two pegs. Then the leftover umbilical cord (with the first peg on) falls off maybe a week later, leaving a bellybutton. How it forms as an innie or outie is entirely random (so I believe).
You have to clean it regularly to prevent infection.
Source: have cut two umbilical cords and cleaned around the belly buttons until the umbilical part falls off.
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