Panniculectomy Vs Abdominoplasty

I've lost 154lbs after having a duodenal switch in August of 2009. I'm not 100% sold on the getting a tummy tuck rather than just a panni removal, I'd like a combination? I don't want to do just the panni removal since I have loose skin above the belly button, if the dr gives me a new belly button without tightening the muscle will I be happy with the result? I don't have weeks to take off work for recovery. I'm also considering having silicone BA at the same time. Thanks for any input.

Doctor Answers (16)

A full tummy tuck may be better for you

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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).

Panniculectomy is usually recommended to people who have lost 100 lbs or more in a relatively short amount of time. The procedure can be carried out on its own or used in combination with abdominoplasty depending on a patient’s condition, and may be covered by OHIP/insurance. Regardless of the form the panniculectomy takes, ideal candidates should have maintained a relatively stable weight for roughly a year prior to surgery and be adhering to a regimen of exercise and healthy eating. Surgery is usually indicated once the person’s BMI (body mass index) is less than 30. We consider a panniculectomy to be exactly what the term describes: removal of the pannus. Only what is hanging down below the patient’s waistline is removed, and no undermining on the abdomen itself is performed. We do not advocate a panniculectomy alone except in extreme circumstances, when a patient’s expectations can be fulfilled. You would probably benefit more from a full abdominoplasty because you mention that you're unhappy with loose skin above your belly button as well. Panniculectomy will probably not achieve the improvement you'd like.


Toronto Plastic Surgeon
5.0 out of 5 stars 63 reviews

Differences Between Panniculectomy & Abdominoplasty

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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. 

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 78 reviews

Tummy tuck versus panniculectomy

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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.

Michelle J. Place, MD
Danville Plastic Surgeon
5.0 out of 5 stars 5 reviews

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Abdominoplasty indicated for most after massive weight loss

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The short answer is that if you are like the majority of my patients with massive weight loss you will do better with a combination of panniculectomy and tummy tuck (abdominoplasty).

Panniculectomy refers to simple excision, removal, of the roll, pannus, of redundant soft tissue in the lower abdomen which falls onto the thigh. Occasionally this procedure is covered by insurance if there is a documented recurrent or chronic infection and rash requiring medical treatment. It does not involve improvement to the mid or upper abdomen or tightening to the abdominal muscles, but can be done in conjunction with anAbdominoplasty which will accomplish these goals.
Abdominoplasty This procedure frees up all of the extra or redundant abdominal skin and fat by removing the excess skin around the abdomen and may be used to tighten the abdominal muscles. Liposuction often is used to lessen areas of the fat layer for an improved result. The procedure involves a side to side incision at the level of the pubic hair line. More sophisticated surgical approaches for Massive weight loss may include additional incisions such as a Fleur de lis, an additional incision in the midline up and down to remove excess skin from side to side (in addition to up and down tightening); a reverse lift leaving scars under the breasts, or a Pubic Lift for redundancy in the pubic region and other modifications that are customized to your particular needs. Because of the complexity and number of surgical options, it is key to choose your surgeon wisely. Make sure that he has experience in this type of surgery, is Board Certified by the American Board of Plastic Surgery. This is why so many of our patients choose Pacific Center for Plastic Surgery.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 45 reviews

Tummy Tuck vs Panniculectomy

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Tummy tuck is mainly to improve shape and contour by plicating your core tight then re-draping the skin. Without the core tightening (muscle repair), its not a tummy tuck, but a panniculectomy (skin and fat resection). Massive weight loss almost always requires tightening of your core. See a board certified plastic surgeon.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.0 out of 5 stars 15 reviews

Body contouring (tummy tuck) after massive weight loss

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If you have lost over 150 lbs from a weight loss procedure, you may need more than a tummy tuck or a panniculectomy.  If you have significant loose skin of your upper/lower abdomen, back, sides and outer thighs, you may actually need a body lift to give you the best outcome.  This is difficult to answer without seeing photos of you or without examining you but most patients with that kind of weight loss will not be treated adequately with a tummy tuck alone.  This means you will likely require an incision that extends all the way around your back (like a belt) to address the loose skin and tissue of your sides and back. If you do have loose skin in those areas and only get a tummy tuck, this will leave you only "half" treated with your front looking good but your back and sides will not.

Although a body lift (circumferential tummy tuck) is a more involved procedure, I recommend consulting with a board certified plastic surgeon experienced in treating and contouring patients after massive weight loss.

Best wishes,

Dr.Bruno

William Bruno, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 150 reviews

Abdominoplasty vs panniculectomy

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When you loose that much weight i would go for the abdominoplasty.They are pretty much very similar in execution.Many times the muscles really don't have to be tightened and again your overall medical condition has to be taken into consideration when making a final decision.

Robert Brueck, MD
Fort Myers Plastic Surgeon
5.0 out of 5 stars 19 reviews

PAnniculectomy vs tummy tuck

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If you do the panniculectomy without the tummy tuck you will get some improvement but most likely you will not be satisfied with it. You will have improvement but  the only tissue removed will be the skin and fat that hang below the umbilicus, there would be no tailoring of the tissue to make it tight.

You would have to take some time off but less than if you did the tummy tuck at the same time. In either case you would likely need a second operation in about a year to remove excess skin and improve the appearance.

You get what you pay for and you would most likely prefer the result of the full abdominoplasty at the time of the panniculectomy even with the time off and you more than likely would save some money if you did it at the same time.  

Walter D. Gracia, MD
Arlington Plastic Surgeon
5.0 out of 5 stars 2 reviews

Make sure you are committed to the entire process of surgery and recovery

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Hi lklk in Grand Rapids,

From your  question it appears as though you are hesitant about tummy tuck because of the muscle plication component which may require you to miss more work. My first piece of advice is to make sure you have enough time off for recovery, regardless of which surgery you choose. In the case of massive weight loss patients, this is especially true because wound healing complications tend to be higher. This is partly due to altered nutrition, poor skin quality, higher rates of seroma, increased extent of surgery, and higher BMI's that are all associated with this patient population.

If you choose a pannicultectomy, look at it as more of a functional procedure to get ride of the hanging apron of skin. You will not have an aesthetic result that compares to a tummy tuck. This procedure is faster, less surgery, and likely has less risk of complications when compared with tummy tuck because there is very limited or no undermining of the tissues.

If you choose tummy tuck, you will have a much better aesthetic outcome, at the trade off of more surgery, and increased risk of complications. The increased risk may not be significant, but only your surgeon can make that assessment. If you choose to have tummy tuck without the muscle plication. This may or may not impact your result significantly, depending if you have much diastasis. Plication does increase post operative discomfort which may increase your recovery time. If you do have significant diastasis, however, it is probably worthwhile to have it done if you are having the tummy tuck. It adds little to the actual length of surgery and can make a significant aesthetic difference.  Foregoing plication because of work related issues comes down to how important fixing the diastasis is to you.

As I mentioned before, regardless of which procedure you choose, make sure you do not short change yourself on the recovery period: it may be better to wait for the right time to do the procedure rather than not being fully committed to the entire process

Best regards,

Lawrence Tong MD FACS FRCSC.

Lawrence Tong, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 18 reviews

Panniculectomy VS Abdominoplasty

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Regarding: "Panniculectomy Vs Abdominoplasty
I've lost 154lbs after having a duodenal switch in August of 2009. I'm not 100% sold on the getting a tummy tuck rather than just a panni removal, I'd like a combination? I don't want to do just the panni removal since I have loose skin above the belly button, if the dr gives me a new belly button without tightening the muscle will I be happy with the result? I don't have weeks to take off work for recovery. I'm also considering having silicone BA at the same time. Thanks for any input."

PANNICULECTOMY = Removal of the skin overhang over the pubis. No removal of excess skin from the lower or upper tummy. No correction of loose Tummy muscles or repair of muscle separation.

(FULL, STANDARD) ABDOMINOPLASTY = Removal of the skin overhang over the pubis, the lower and upper tummy with tightening of loose Tummy muscles and repair of muscle separation.

Odds are that the morbid obesity ( and certainly any pregnancies) you had DID stretch and separate your tum,my muscles. By choosing not to get them repaired you may be getting a less than great result where the skin excess is corrected by you would be retaining a pooch and a bulging tummy. I would recommend you have the operation which stands to get you the BEST result rather than a compromise that would snatch defeat out of the jaws of victory.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 62 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.