If a person needs a hernia repair & panniculectomy (both covered by insurance), will an abdominoplasty take care of both things?

Question

Sorry that I do not exactly know what a surgeon does in an abdominoplasty... If a hernia operation (due to formerly being very overweight) can be done at the same time as a panniculectomy, where both the panniculectomy and hernia are covered by insurance, is it essentially an abdominoplasty? (without a mesh being put in because the person is no longer overweight, so suturing the muscles back together should prevent a hernia from happening again. Maybe I'm totally wrong?)

Gary Lawton, MD, FACS · Answer

The panniculectomy is a limited form of the tummy tuck with lesser cosmetic outcomes.  It is designed for patients with a large overhanging pannus that causes rashes and other medical problems.  It often does not involve muscle reconstruction.

David Tauber, MD · Answer

A typical abdominoplasty is a powerful cosmetic procedure
that often removes and reposition tissue of the abdominal wall for better
contour and aesthetics. The basic procedure includes elevating a flap of belly
skin and fat; separating it from the belly muscles all the way up to the ribs.
During this dissection, the belly button is separated from the surround skin
and left attached to the belly wall. The flap is pulled down tight and the
excess skin is removed. The abdominal muscles are then sutured together to
remove the laxity (plicated). Small, incidental umbilical hernias may be repaired at this time. Finally, the belly button is brought out to the
surface through a new hole in the flap (transposed) and the incisions are
closed.

A panniculectomy is a basic guillotine removal of an
overhanging pannus for medical reasons. There is no elevation of the belly
skin, the skin is not pulled tight, the belly button is not transposed (and is
sometimes removed), and the muscles are not tightened.

A hernia repair is a reconstructive operation in which a
defect in the abdominal wall repaired with sutures and usually reinforced with
some sort of “mesh” for additional support. Hernias are notoriously difficult
to keep closed and have a high recurrence rate – especially with suture repair
alone. Hernia repair does not include elevation of the skin of the
abdomen beyond what is required to gain access to the hernia. A hernia repair
also does not include any other aspect of an abdominoplasty including plication
of the abdominal wall, transposition of the belly button, or the excision of any skin not involved in the hernia.A detailed examination will help delineate the best
surgical treatment. Consultation with a plastic surgeon would be the next best
step.

Don W. Griffin, MD · Answer

Just because you were overweight does not mean that you have a hernia, but you may have diastasis, or looseness of the abdominal muscle. A hernia is a true defect in the abdominal wall and is not caused by losing weight. A panniculectomy is a procedure in which the overhanging skin of the abdomen is cut off. It does not involve elevating the loose abdominal skin and pulling it downwards and does not involve redoing the umbilicus like in an abdominoplasty. If you have diastasis or a small hernia, most surgeons do repair this when they perform an abdominoplasty, but the abdominoplasty is not covered by insurance even if you have a hernia.

Kenneth Hughes, MD · Answer

A panniculectomy only involves removal of the hanging tissue.  It does not involve the extent of tissue undermining or tissue removal or plication or umbilical transposition.Kenneth Hughes, MDLos Angeles, CA

Vincent N. Zubowicz, MD · Answer

When a plastic surgeon performs an abdominoplasty is customary to repair any loose connective tissue as well as any defects to the abdominal wall such as hernias.

Robert Oliver Jr., MD · Answer

Putting the muscles "back together", as in an abdominoplasty,  is not really a hernia repair. A hernia is not stretched tissue, but a true defect or tear in the structural tissue. Primary repair of this by sewing it back together is not a sound surgical hernia repair, particularly in weight loss patients as the native tissue is so compromised. The literature would suggest mesh prosthetic reinforcement would be needed in most instances

Josef Hadeed, MD, FACS · Answer

A panniculectomy removes the loose hanging skin from the lower abdomen, whereas an abdominoplasty tightens the muscles of the abdomen.  A hernia repair addresses an area of weakness of the abdominal wall.

Jordan P. Farkas, MD · Answer

These operations are much different that an abdominoplasty. An abdominoplasty will remove excess skin and tighten your muscle in the midline. However, usually patients will achieve the best results from am abdominoplasty once they are at their ideal body weight. Panniculectomies generally resect large overhanging tissue that causes rashes, and hygeine problems in overweight individuals. Hernias are defects in the abdominal wall and unless umbilical in origin are usually fixed by general surgeons and cannot be substituted for an abdominoplasty.

Tom J. Pousti, MD · Answer

Congratulations on your weight loss!It will be important for you to learn about differences between panniculectomy and abdominoplasty (tummy tuck) surgery. The operations are different, with different indications and different outcomes. The panniculectomy operation is designed to remove the lower abdominal wall pannus (this is the tissue of the lower abdominal wall). Muscle repair is not a part of the panniculectomy operation.  It is sometimes considered a medically necessary procedure and cover through some insurance companies.On the other hand, abdominoplasty (tummy tuck) procedure is generally considered a more cosmetic operation designed to improve the contour of the entire abdomen, including the upper/lower abdomen as well as the pubic area… Muscle approximation (plication) is generally performed with this surgery as well.  This operation is considered “aesthetic” in nature and not covered through insurance companies.My best recommendation: select your surgeon carefully. Make sure that he/she is a well experienced board-certified plastic surgeon who can demonstrate significant experience achieving results. Then, communicate your goals carefully with him/her. Working together, you will be able to design the operation that will best achieve your desired outcome. I hope this, and the attached link, helps. Best wishes.

If a person needs a hernia repair & panniculectomy (both covered by insurance), will an abdominoplasty take care of both things?

Answers (9)

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