Do You Think I Should Have Muscle Repair if Not Satisfied with Panniculectomy? (photo)

Oct 2012 I had what my ps called a modified tt. However he never felt the split in my tummy from having 4 babies. I told him I was scared of pain and I think now he must have thought no mr meant less pain. However under my breast above my bb it looks like a half of basketball. at a post op he said I needed to lose weight. However this is solid not fat. I am sure it is the recti muscle split. I need to know if major surgery is the only option. Or is there a procedure that can fix this that is not as major?

Doctor Answers 6

Do You Think I Should Have Muscle Repair if Not Satisfied with Panniculectomy? (photo)

First the difference between the before and afters is great! But the superior bulge is a split recti. Only aggressive surgery plus trying 20 pounds weight loss will help. 

Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Do You Think I Should Have Muscle Repair if Not Satisfied with Panniculectomy?

     The visceral fat component may be quite significant, and this can be remedied to some extent with weight loss.   This will not be accessible with liposuction.  Liposuction can reduce the thickness of the subcutaneous fat layer, and plication can improve the abdominal wall laxity.  A physical exam would be necessary to determine the correct measures to be taken.

Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Panniculectomy usually does not involve muscle repair

The major difference between an panniculectomy and an abdominoplasty is the repair of the anterior abdominal wall fascia.  Although it is not always predictable in a patient that is overweight some assessment must be made of the following:

  1. Excess skin
  2. Excess fat
  3. Anterior abdominal wall laxity
  4. Visceral or intra-abdominal fat

It can be a judgement call, based on experience, to offer or plan each surgical procedure.  In your particular case losing weight will be of benefit as the first 10 pounds you lose will be visceral fat, then have your abdomen reassessed.  Unfortunately there is not way to repair the fascia without re-elevating the entire abdominal wall skin flap. 

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Muscle repair if not satisfied with paniculectomy?

While you may have some diastasis present and it may be contributing to some degree, I can assure you it is not the primary cause of your concern. In order to have had a significant improvement in the upper abdomen starting where you did it would have required require a Saldanha technique with extensive liposuction in addition to excision of all the lower skin and excess fat. In other words a full and aggressive TT using a lipoabdominoplasty method and not a "panniculectomy". I tell patients seeking panniculectomy alone (because insurance will cover it) not to expect to look the way my patients do who have the cosmetic portion as well. Those are two different procedures completely.

In addition it appears you still have a significant amount of excess weight inside your abdomen and would need to lose more weight overall.

I would recommend getting to as close to ideal body weight as you can and letting a plastic surgeon reexamine you and then see what will be required. I promise you if you lose the weight much less will need to be done although you will require reoperation to get to where you want to be.


Grady B. Core, MD
Birmingham Plastic Surgeon
4.6 out of 5 stars 12 reviews

Do You Think I Should Have Muscle Repair if Not Satisfied with Panniculectomy?

You appear to have either excess fat in the upper abdomen or abdominal wall laxity. This will require another surgery either way.

Kurtis Martin, MD
Cincinnati Plastic Surgeon
4.9 out of 5 stars 72 reviews

Do You Think I Should Have Muscle Repair if Not Satisfied with Panniculectomy?

It looks like you have had a rather dramatic improvement. 

Without an examination, it is not really possible to assess the amount of improvement you might get with a muscle repair. I do concur in general with your surgeon's advice to lose weight. What you are feeling are abdominal contents, including organs and fat, and losing weight will diminish the fullness in that areal. 

You might benefit from muscle repair, but this is an operative procedure involving exposure of the abdominal wall using your current incisions for access, and it is a major procedure. As to pain, probably more than you had from the original TT. The muscle repair contributes significantly to the discomfort after a TT. 

A discussion with your surgeon about the pros and cons is in order. Best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.