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.

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.

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. 

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