If the Dr gives me a new belly button without tightening the muscle will I be happy with the result?

Hello,
Thank you for your question and congratulations on your impressive weight loss!
While panniculectomy (removal of hanging skin below the belly button) generally provides good functional benefits (no rashes, easier to move around, etc), it does not provide the aesthetic (appearance) benefits of panniculectomy with tummy tuck (which included tightening of abdominal muscles and contouring of the full abdomen and hips). The downside is that insurance often covers panniculectomy, but not tummy tuck. I frequently perform breast augmentation with tummy tuck (this combination is also known as “mommy makeover”. For most patients the recovery time for a tummy tuck is not significantly longer than that for panniculectomy alone.
A video consultation with a cosmetic surgeon will help you better understand the differences between the different procedures, what payment options are available, and what you can expect for recovery time.
Best wishes,
Dr. Moein

If it is safe to perform a tummy tuck based on the amount of fat in the upper abdomen, then a tummy tuck is a better operation than the panniculectomy, but that would have to be determined on a case by case basis.

Body contouring comes in many different varieties. Panniculectomy is mainly targeting excess skin removal. A true panniculectomy does not create a new belly button but this is frequently not the best option for most people who also have extra skin above the belly button. So normally it's preferable to move the belly but to improve the overall contour and result, which moves it into the gray zone of abdominoplasty. Insurance companies often don't reimburse for the extra work involved.  Their focused on treated the redundant skin that is causing the rashes and irritation. Most patients take 7-10 days off but have less limitations post op vs. full abdominoplasty with rectus plication. Rectus plication targets restoring the abdominal musculature that's become distorted. This will help flatten the final outcome of the abdomen. This is essential a large hernia repair in many ways and requires additional recovery to protect the repair. It's also more painful. Normally on exam you can tell how much this will benefit a patient based on how large the diastasis or separation is.  If there's not a big separation most patients are  happy with the result without tightening the muscle. Most patients take 14 days off from work. Liposuction is frequently included to improve the flank contours. This doesn't add significantly to recovery. Breast augmentation doesn't increase the recovery length and is frequently combined. If you've lost that amount of weight you would likely benefit from a breast lift as well. I hope this helps. Always see a board certified plastic surgeon for an inperson consultation to get more specific recommendations for your situation. 

A panniculectomy will only address the skin and lipodystrophied fat in the lower abdomen bellow the belly button. A full tummy tuck would address the loose skin on the upper abdomen above the belly button. Tightening the muscles (rectus plication) will give you a smaller waist and help with the abdominal wall protruding out. Recovery would be easier without the muscle repair but if you are undergoing the large surgery, I would recommend doing the muscle repair.

Both of these options are wonderful in terms of reshaping your body. What is an important decision to make is whether you will need muscle fascia tightening.  If your muscles are loose, you will probably need an abdominoplasty instead of a panniculectomy. Best, Dr. Karamanoukian

Panniculectiony is removal of the overhanging skin above the pubis and below the belly button. It does not address muscle tightening and repair and general aesthetic shape of the body. It is usually done for patients after massive wt loss that have a droopy lower abdomen that is causing skin breakdown in the fold.Tummy tuck surgery, also known as abdominoplasty is a surgery that aims to create an abdominal profile that is smooth and firm by removing excess fat and skin and by tightening weakened or separated muscle.Both these procedures are very popular, however, it's best to make an appointment to see what your options are. Best of luck and Congratulations on your achievement. 

Hello! Thank you for your question! I hope that these answers help! A panniculectomy is an excellent method for removing the excess skin and soft tissue of the lower abdomen (abdominal panniculus), often caused by weight loss. It is mainly performed to ameliorate symptoms caused by the abdominal apron such as hygiene issues, excoriations, rashes/infections, back pain, etc. A panniculectomy gives almost immediate relief from these issues as well as has been shown to stimulate additional weight loss as your activity level is increased after removal of the panniculus. An abdominoplasty is more of an aesthetic procedure in that as opposed to simply excising this excess tissue in a wedge to relieve complaints, an abdominoplasty focuses more on abdominal contouring, abdominal wall tightening, re-insetting the belly button, as well as often times the addition of liposuction. I believe you would be better served by a full tummy tuck, in order to address your abdominal wall laxity as well as contouring of your flanks/hips, and upper abdomen. I would highly recommend continued diet and exercise prior to any consideration for a panniculectomy or body contouring as getting down to your ideal weight prior to the procedure will certainly give you the best results as well as be the safest for you. Neither one is a weight loss procedure. Also, a continued healthy and active lifestyle will be needed in order to maintain the benefits that the procedure has given to you. You should consult with a plastic surgeon at anytime to go over options and in order to assist you in deciding which procedure(s) would be right one for you. Best wishes for a wonderful result!

Congratulations on your weight loss! It is unfortunate that one of the side effects of massive weight loss is the development of a pannus (apron of skin). A panniculectomy will only remove the excess skin and fat that is forming the apron of skin, and won't do anything for anything above this. That's why a tummy tuck would probably be better for you.

It’s not unusual for massive weight loss patients to
develop loose, saggy abdominal skin. This excess skin can cause a variety of
functional problems including chronic rashes, infection, and back pain. In
addition, loose abdominal skin may cause aesthetic deformities which effect
self-esteem and self-image.

For these reasons, patients frequently seek corrective
surgery following massive weight loss. When this situation arises, a variety of
treatment options exist that address the skin, fat, and underlying muscles.
These procedures are tailored to the patient’s specific anatomic findings and
unique aesthetic goals.

In some cases, an abdominal panniculectomy can be
performed. This procedure involves removal of excess lower abdominal skin. When
this skin apron is removed, the umbilicus and underlying muscles are left
alone. This procedure has a significant impact on function, but has aesthetic
limitations. These include continued upper abdominal loose skin, pubic skin
sag, and weak abdominal muscles.

For these reasons, it’s not unusual for patients to
request abdominoplasty surgery. This procedure not only removes excess lower
abdominal skin, but also removes excess upper abdominal skin and tightens the
abdominal muscles as well. This procedure requires detachment of the umbilicus
and transposition to a higher level. It’s associated with
improved functional results and dramatically improved abdominal aesthetics.
Unfortunately, tightening the abdominal muscles does occasionally prolong the
recovery period.

It’s important to realize that each patient’s situation
is unique. For this reason, it’s important to discuss your aesthetic goals with
your plastic surgeon. Your plastic surgeon should be able to formulate a
treatment plan that’s appropriate for your aesthetic goals and life style. In
your case, it may not be appropriate to tighten your abdominal muscles. 

Losing over 154lbs is a major accomplishment but it does leave you with loose skin and muscles.  The panniculectomy with removal of the overhanging loose skin will improve any problems with rubbing, rashes and wearing certain clothes but it does not tighten the muscles or improve loose skin above the umbilicus.  The advantage of tightening the core with muscle plication is tremendous and there is an overall improvement in the appearance of the abdomen with going above the umbilicus.  The muscle tightening can add to the recovery time with added tightness or discomfort but not by much.  If you are going to undergo the procedure and deal with the recovery time, I would recommend getting the benefit of the tummy tuck for core strength and appearance.  If you are only interested in improving rashes or skin breakdown and wearing clothes better then the panniculectomy is a good choice.