I lost over 100 pound and have a lot of excess skin handing down. Does a standard abdominoplasty with umbilical transposition and fascia plication also remove the skin hanging down or do I have to have a panniculectomy and the standard abdominoplasty. Also my mons pubis is large and if I get the other surgery I have read that I could also have surgery to reduce that area too. Is that like paying for three separate surgeries? About how much more would it cost to have the mons pubis area done?
What is a Standard Abdominoplasty?
Doctor Answers 9
Standard Abdominoplasty plus Mesh Reinforcement
The routine abdominoplasty resects excess skin and repairs the fascia in the midline from the ziphoid down to the pubic region. The mons pubis area is debulked and lifted at the same time as part of the standard abdominoplasty. If you have lost over 100 lbs, you have probably damaged your fascia and I recommend mesh reinforcement of the fascia in addition to the standard abdominoplasty. Abdominoplasty with Mesh Reinforcement helps patients reduce weight and maintain the reduced weight. This is an alternative you should consider.
Gary Horndeski, M.D.
I would be happy to simplify this for you. A panniculectomy is the removal of the excess skin from your abdomen which is a standard part of an abdominoplasty. It also implies transposition of the navel. The only ting it does not imply is the muscle tightening part which is often but not always used in a full abdominoplasty. When designed properly, it will also deal with the looseness of the Mons area. When I charge for this procedure, I charge the entire thing as one procedure. Do not overpay by thinking that you are having three separate procedure. It is really only one!
One surgery will do it all
Thank you for your question. One surgery will take care of all of the issues you describe. Most patients who have 100 lb weight loss have a significant amount of laxity and therefore are a candidate for either an extended tummy tuck that goes from one side to the other or a circumferential tummy tuck that goes all of the way around. My recommendation is to find a well qualified board certified plastic surgeon that has can show you good before and after photos of extensive tummy tucks or circumferential tummy tucks.
All the best,
Dr Remus Repta
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Abdominoplasty vs Panniculectomy
Thank you for your question and congratulations on your weight loss. Technically speaking, a panniculectomy involves only skin removal below the level of the belly button. It does not involve an umbilical transposition or muscle tightening (plication). These latter two procedures are considered additional and are part of a tummy tuck/abdominoplasty. I suspect that most surgeons would not charge you separately for a panniculectomy in addition to the abdominoplasty. A cosmetic abdominoplasty includes the skin excised in a panniculectomy procedure. In my practice, I include reshaping of the mons area as part of the abdominoplasty. Depending on the extent of skin excess, you may require a circumferential tummy tuck (body lift) which would incur further cost. Liposuction may be included as well, but may be extra depending on your surgeon's policies. Consult with your board certified plastic surgeon to make sure all of your questions are answered prior to surgery. Good luck!
Abdominoplasty and /or panniculectomy?
Congratulations on your weight loss! You would probably be a great candidate for an abdominoplasty A panniculectomy refers to just removing the apron of skin between the navel and pubic area . Most likely you will need excess skin removal from the upper abdomen as well and tightening of the abdominal musculature. The pubic mound can be reshaped at the same time. Have a consultation with a plastic surgeon to discuss your specific situation and recommended procedures
What is a Standard Abdominoplasty?
You are trying to become an educated patient by reading (smart), but you cannot get the insight and understanding necessary to make the correct decisions for yourself without in person consultation with one or more good plastic surgeons.
You ask both technical surgical and cost questions, the answers to which vary between operators, another reason to raise these issues in the forum of personal office consultation, specific to your situation.
Abdominoplasty After Weight Loss
Every patient should have their plastic surgery procedure individualized to their own body and to their personal goals. A one-size-fits-all approach really fits no one. After weight loss there are more features to restore than for the person with skin that is not stretched out. Most need to have the extra skin removed, including a lift of the pubic region. For most the abdominoplasty needs to extend further onto the back. A better result happens with a lower body lift than an abdominoplasty alone. Correcting the mons is not a separate surgery in my practise but a lower body lift is a biggersurgery than a tummy tuck and thus costs more.
An extended tummy tuck designed for weight loss patients will get you the results you want
A panniculectomy is a surgery to remove skin and fat that hangs over your mons pubis (the hair-bearing area of the pubic area). It does not address any muscle tightening or removal of skin that is loose above the area that hangs over the mons pubis.
From having done a large volume of weight loss patients, I can tell you that when you lose 100 lbs, there are usually three folds of skin that needs to be addressed on the abdomen. The first fold is the skin that hangs over the belly button area from your upper abdomen. The second fold is the apron of skin that hangs over the pubic area in the lower abdomen. The third fold is the mons pubis, itself that hangs down like a little fanny pack.
An extended tummy tuck that begins with an incision as low as possible will address all three folds and give you the best appearance. An extended tummy tuck basically includes addressing the loose mons pubis, the panniculectomy, and the standard tummy tuck.
This may have different answers from different surgeons.
A panniculectomy is defined by most as simple excision of skin and fat below the navel. It is "defined" in the AMA current procedural therapy manual, and given a CPT code of 15830. That same codebook defines abdominoplasty as code 15947, which includes removing excess skin and fat, transposing the navel, and tightening the abdominal wall fascia, and notes that this code should be used in addition to the panniculectomy code.
For insurance purposes, these are two separate operations. A reduction of the mons would be another procedure for billing purposes.
For most surgeons, if this is done a a cosmetic case without insurance, the TT fee would include the panniculectomy, though the fee might well be higher than the fee for a patient with a simpler TT that would require less operating time. There would likely be an additional fee for a mons reduction.
A mons reduction alone would probably cost about half the fee for a TT, although that might be different from office to office.
When you ready for an in person consultation, RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified, but also is a member in good standing of the major plastic surgery organization in the U. S.
Congratulations on the weight loss.
Thank your for your question, best wishes.