Does my apron hang enough for panniculectomy? (photo)

Question

Looking to see if I’d be a candidate for a panniculectomy. Female 5’6 190lbs 28yo Two c sections Highest weight 250 after pregnancy I know this procedure does not tighten anything and is not for cosmetic purposes. I keep having a rash under the apron , bad itching and foul smell. I’ve tried monistate, powders, and clean it daily. I As well as how far up and to the side does this generally remove? Will I loose my belly button? I do have a hernia above my belly button as well.

J. Timothy Katzen, MD, FACS · Answer

Hi Kayann3773, Thank you for your question regarding does my apron hang enough for panniculectomy.  Thank you for your history and your picture.  Based on a single photo and without a thorough physical examination and any knowledge of your insurance (HMO, Medicare, POS, PPO), most plastic surgeons would agree that you qualify for a panniculectomy.  Typically, in order for your insurance provider to authorize coverage for a panniculectomy, the following prerequisites must be satisfied: 1) Your abdominal pannus must extend inferiorly beyond the level of the pubis or pelvic bones 2) If you have lost in excess of 100 pounds through dietary modifications and physical activity, you must maintain a stable weight for a period of six months. If you have lost in excess of 100 pounds through weight loss surgery, your weight must have remained stable for a period of 18 months 3) You must possess a documented medical history, recorded within a healthcare provider's records, indicating recurrent rashes or persistent ulceration unresponsive to antibiotic, antifungal, or steroid ointments, and 4) you must have documented evidence of mobility impairments or disruptions to activities of daily living.   A panniculectomy conducted exclusively for the improvement of low-back discomfort is regarded as not medically essential and is generally not eligible for coverage.

There exist eight distinct varieties of abdominoplasty procedures. The conventional options include the standard low horizontal abdominal contouring procedure, the extended abdominoplasty, the high lateral tension abdominoplasty, the vertical abdominoplasty, the inverted T or fleur-de-lis (FDL) abdominoplasty, the mini abdominoplasty, the reverse abdominoplasty, and the lateral abdominoplasty. Various types of abdominoplasty are applicable to distinct anatomical issues. During an abdominoplasty, an incision is executed beneath the pannus, and dissection is performed up to the sternum or rib cage. The rectus abdominis muscle plicated (brought together)  resulting in a significantly flattened abdominal profile in comparison to a panniculectomy. In your particular situation, the abdominoplasty would be analogous to a panniculectomy in that an incision is performed beneath the abdominal pannus. Furthermore, the panniculectomy bears resemblance to abdominoplasty in that surplus skin and adipose tissue are excised from the pendulous pannus.  Nonetheless, the resemblance between a panniculectomy and an abdominoplasty largely concludes at that point. An abdominoplasty constitutes a substantially more invasive surgical intervention, yielding generally more optimal and preferable outcomes in comparison to a panniculectomy. Furthermore, during an abdominoplasty procedure, the umbilicus is realigned and cosmetically enhanced to achieve an improved aesthetic presentation. Furthermore, abdominoplasty is considerably more advantageous than panniculectomy due to the greater extent of skin and fatty tissue removal achievable during a tummy tuck compared to a panniculectomy. Generally, surplus skin and adipose tissue from the superior pubic area extending to above the umbilicus are excised. Please be advised that, in the course of a panniculectomy, only the skin and adipose tissue extending from the pubic area to the superior border of the pendulous pannus are excised. Furthermore, liposuction is commonly conducted in conjunction with an abdominoplasty. Generally, for nearly all patients, an abdominal tuck or abdominoplasty is markedly more advantageous than a panniculectomy.  Numerous insurance providers authorize the panniculectomy; however, regrettably, not all insurers approve the more comprehensive procedure, namely the tummy tuck. In your case, most plastic surgeons would favor an abdominoplasty over a panniculectomy because you will achieve better results.  Most plastic surgeons would suggest you spend the extra money on a tummy tuck to achieve the best possible results.  I trust this provides clarification concerning the distinction between a panniculectomy and an abdominoplasty. It is important to note that, in general, a panniculectomy solely excises the pannus, whereas an abdominoplasty involves the comprehensive treatment of the entire abdominal wall and typically yields significantly more favorable results in comparison to a panniculectomy.  If you have any more questions regarding the panniculectomy, extended lower body lift, lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, contact an experienced plastic surgeon. Since the panniculectomy or lower body lift is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing the panniculectomy or lower body lift. Do your research.  Make sure they have performed at least 100 panniculectomies or circumferential lower body lift 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 lower body lift plastic surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (Plastic Surgeon, President of  the American Society of Bariatric Surgeons, 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, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Andrew Ray, DO · Answer

If you are looking to have it covered by insurance make sure to talk to pcp get referrals document the skin issues. If you are not looking to use insurance, a regular tummy tuck will do the trick. I always recommend liposuction with a tummy tuck for a very nice refined look, but it is not an obligation. Your belly button will remain and just get remade in your new abdominal wall.

Camille Cash, MD · Answer

It appears you are a candidate for a panniculectomy.  Your hernia can likely be addressed at the same time.  Further photos or an exam are needed to determine what you can expect in terms of results.  You may want to consider a tummy tuck which would address the hanging skin, subcutaneous fat and tighten the abdominal wall.

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