Thank you for your question on what you do with your abdomen after massive weight loss. Also, whether a Fleur-de-lis panniculectomy (FDL) panniculectomy and mons lift or mons reduction are the right procedures for you after massive weight Loss. Congratulations on your weight loss. What a great accomplishment. In regards to your abdomen, there is no such thing as a “fleur-de-lis panniculectomy”. Therefore, insurance would only cover a panniculectomy. That means they would only cover a “horizontal” panniculectomy. A panniculectomy would remove the pannus. The pannus is the part of the lower abdomen (not above the belly button) that hangs over the pubic region. The vertical component of the upper abdomen would not be covered by insurance, as this is “cosmetic”. In your case, I think a panniculectomy would be sub-optimal surgery. Because of your weight loss, the muscles have been stretched and the fascia has been destroyed. Therefore, in your case, I would suggest an extended tummy tuck or abdominoplasty and mons reduction. An incision is made in the lower abdomen, tissue dissection is carried up to the rib cage and the anterior abdominal muscles are sutured together. If you do not suture the muscles together, your abdomen will still protrude due to the fact you have lost so much weight. If you just undergo a panniculectomy, without the muscle repair, your abdomen will still be distended. I do not think you need a vertical component or fleur-de-lis incision. In my hands, I believe that upper portion of your abdominal wall can be removed by pulling the skin during the extended tummy tuck. In regards to insurance coverage, a panniculectomy can be covered if you meet insurance criteria. Criteria for panniculectomy coverage includes things like chronic skin rashes refractory to antibacterial/antifungal creams and lotions and your pannus must cover your pubic region. Also, most insurance companies require a stable weight for 6 months if you lost weight through diet and exercise and for 18 months if you lost weight through gastric surgery. Usually, insurance companies do not cover the panniculectomy just for low back pain. In comparison to a panniculectomy, a tummy tuck is a more invasive and expensive procedure and is not covered by insurance companies. Insurance companies consider the tummy tuck to be a cosmetic procedure. Thank you for posting what to do with your abdomen. I specialize in reconstructive plastic surgery after weight loss. If you have any more questions regarding the panniculectomy, tummy tuck, extended tummy tuck, high lateral tension tummy tuck, abdominoplasty, lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please contact my office. Since the panniculectomy or extended tummy tuck are big procedures, please seek an experienced, board certified plastic surgeon with significant experience performing the panniculectomy or extended tummy tuck. Do your research. Make sure they have performed at least 100 panniculectomies or extended tummy tuck surgeries and have the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf. If you cannot find an experienced, panniculectomy or extended tummy tuck surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)
