Panniculectomy vs Tummy Tuck - which would be best for me? (photos)

Question

I had gastric bypass August 2020 and lost 120 lbs. I’ve always had a Panniculus that breaks out if not kept clean/dry (usually get 20 hours after a shower before rash breaks out even in winter) so im ready for removal. However can my upper stomach be pulled down at the same time or does that also become tummy tuck? I’ve seen similar stomachs qualify for just panel so im curious.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding whether you need a panniculectomy or a tummy tuck. In my opinion, you get far better results with a tummy than with a panniculectomy. By definition, a panniculectomy only removes the pannus. The pannus is that excess skin and fat that hangs over the pubic region. Suppose you look at your pictures carefully. You will also see that you have an area of skin and fat above the belly button. This will not be treated with a panniculectomy. A tummy tuck is a far superior procedure compared to a panniculectomy. During a tummy tuck, the roll above your pubic region and the belly button will be permanently eliminated. Through that tummy tuck incision, the rectus abdomens muscle would be repaired. The mons would be lifted and reduced. Excess skin and fat above the mons region would be removed, and a new belly button would be established. None of these are accomplished during a panniculectomy except for removing skin and fat hanging over the pubic region. Therefore, I would highly suggest a tummy tuck over a panniculectomy.

Andrew Ray, DO · Answer

Congratulations you look amazing!

So a panniculectomy is a basic functional surgery whose only goal is to remove the hanging skin, not to relocate belly button, not to fix muscles and certainly not to do any sculpting liposuction. Insurance if approved will cover this. Conversely a tummy tuck will pull down your abdomen, fix your muscles, remove the pannus and if you add liposuction will improve your abdominal contours. For simple comparison. A tummy tuck without lipo is approx 10-12k for everything surgery, anesthesia and facility, if you add flank and abdomen lipo cost is approx 14-16k. I know a lot more than insurance covering a panniculectomy but with significantly better functional and aesthetic results.

Adam Kinal, MD · Answer

Dear JZ0620, Thank you for your question and photographs. However, getting a proper assessment with an in-person examination is easier. Don't hesitate to contact several Board Certified Surgeons who specialize in these procedures to get their evaluation. A Tummy Tuck will address the skin of the upper and lower abdomen and more. Still, it is advised to seek an in-person evaluation with an experienced surgeon specializing in these procedures. Good luck.

Irena Karanetz, MD · Answer

Hi, Thank you for the question. 
First off, congratulations on your weight loss! If you are wanting to lose that additional weight, I would try to do so before the surgery only because this can change the results of your surgery. 
Based on your photos, you appear to be are a great candidate for a tummy tuck. During tummy tuck surgery excess lose skin below the belly button is removed, new belly button is created to look natural and have no scars on the exterior and your muscles can also be plicated resulting in a flatter abdomen. Liposuction can also be added to further improve the contour of your abdomen and achieve a more hourglass shape.
During Panniculectomy, only the pannus ( extra loose skin) is removed without any contouring of the abdomen performed. If panniculectomy is approved through insurance, tummy tuck procedure can be often added for a lesser fee to achieve the best cosmetic result.
I would recommend an in person evaluation by the plastic surgeon to further evaluate the thickness of your skin and status of your muscles. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. 
I hope this helps.Best regards, Dr. Karanetz
Dr. Irena KaranetzFellowship-TrainedBoard Certified Plastic Surgeon

Rodolfo Castillo, MD · Answer

Hello JZ, 
As your weight loss journey has progressed and based on your photos I believe the procedure would be an extended abdominoplasty, which like you mention would pull down excess skin from upper stomach and that extends towards the back area, which helps define waistline. Another option is an abdominoplasty in fleur de lis abdominoplasty, which also targets horizontal skin excess. Each procedure is customized to each patient's case and desired goals, so it would be best to address your options and concerns on a consultation. Wish you the best of luck on this next step of your journey.

Daniel Barrett, MD · Answer

Dear JZ0620,
it is hard to tell for sure without an examination. Panniculectomy would remove loose skin under your belly button but tummy tuck would remove loose skin above and below belly button and tighten abdominal muscles. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

Congratulations on your impressive weight loss!  A panniculectomy will only remove the hanging apron of skin.  If you are wanting a more contoured abdomen the tummy tuck is the right procedure.  It will address the excess skin throughout the abdomen, remove excess subcutaneous fat and correct abdominal wall laxity.  See a board certified plastic surgeon near you to learn more.

Melissa Marks, DO, FACOS · Answer

Hi. First off CONGRATULATIONS on your weight loss! That is a huge accomplishment. To get the best results I would recommend a full tummy tuck. You do have upper abdominal wall fullness from the excess skin and this would not be addressed from the panniculectomy alone. However, If this does not bother you then a panniculectomy with remove the excess hanging skin at the bottom of your abdomen and will help with the rash as well. Hope this helps!

H. Joseph Naim, MD, FACS · Answer

Excess skin is very common after massive weight loss. The answer to the above question in similar scenarios is always the same: Get a Tummy Tuck for a better cosmetic results!
There are cases that the insurance only covers the Panniculectomy or one may pay less for Panniculectomy vs. Tummy Tuck. But if you looking for the best results, Tummy Tuck that also includes muscle tightening and repositioning of the belly button, plus removal of excess skin at public area, would be best.

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