FDL or reverse tummy tuck? (Photo)

Question

Can i get a reverse tummy tuck? I was approved for the panniculectomy by insurance. 37 y.o. female with a history of massive weight loss (250+ lbs) following robotic sleeve gastrectomy on 11/21/2022. I’m 5’4 185 lbs

Semih Yildiz, MD, FEPOBRAS · Answer

A reverse tummy tuck is usually designed for loose skin mainly in the upper abdomen, with the incision hidden along the lower breast fold. It is not typically the best operation for a large lower abdominal pannus or for the vertical and horizontal skin excess often seen after massive weight loss.

In your photos, there appears to be significant lower abdominal overhang with loose skin extending centrally and upward. That pattern is more commonly treated with a panniculectomy, extended tummy tuck, fleur-de-lis tummy tuck, lower body lift, or some combination depending on your exam and goals. A fleur-de-lis approach can be helpful after major weight loss when there is both up-and-down looseness and side-to-side looseness, because the vertical incision allows the surgeon to narrow the waist/central abdomen in a way a standard horizontal incision cannot. The tradeoff is the visible vertical scar.

It is important to separate an insurance-approved panniculectomy from a cosmetic tummy tuck. A panniculectomy generally removes the hanging apron of skin to improve hygiene, rashes, or functional problems. It may not include muscle repair, belly button reshaping, waist contouring, liposuction, upper abdominal tightening, or the amount of contour improvement many patients expect from a full abdominoplasty or fleur-de-lis tummy tuck.

At 5'4" and 185 lbs after a 250+ lb weight loss, you should also ask about surgical safety, nutrition labs, protein status, anemia, vitamin levels, and whether your weight has been stable. Massive weight-loss patients can have a higher risk of wound healing problems, fluid collections, and delayed healing, so planning the right operation in stages may be safer than trying to do too much at once.

I would recommend consulting a plastic surgeon experienced with body contouring after bariatric weight loss. Bring the insurance approval and ask specifically: what tissue will be removed, whether the belly button will be transposed, whether muscle repair is planned, whether a fleur-de-lis or lower body lift would give a better contour, and what portion would be insurance-covered versus cosmetic.

J. Timothy Katzen, MD, FACS · Answer

Hello Loving334869, thank you for your question regarding whether to opt for an FDL or reverse tummy tuck.

First of all, congratulations on your incredible weight loss! Losing 250+ pounds is a remarkable achievement, and you should be very proud of your journey.

Based on the amount of excess skin you have, I would recommend a Fleur de Lis (FDL) tummy tuck or even a circumferential body lift if your buttocks and hips bother you.

Fleur de Lis (FDL) Tummy Tuck
The FDL tummy tuck involves both a vertical and horizontal incision, which allows for the removal of excess skin and fat from the upper and lower abdomen. This procedure is particularly effective for patients who have experienced massive weight loss, as it provides significant skin tightening and contouring, especially in the midsection.

Circumferential Body Lift
A circumferential body lift, also known as a 360 body lift, addresses excess skin and fat around the entire torso. This procedure not only tightens the abdomen but also lifts the buttocks and outer thighs. It's an excellent option if you have concerns about your buttocks and hips in addition to your abdomen.

Reverse Tummy Tuck
A reverse tummy tuck primarily addresses excess skin in the upper abdomen and is less comprehensive compared to the FDL or circumferential body lift. Given your significant weight loss, a reverse tummy tuck may not provide the extensive skin removal and contouring you need.

In summary, considering the amount of excess skin you have, I believe you would benefit most from an FDL tummy tuck or a circumferential body lift. These procedures will help you achieve a more contoured and aesthetically pleasing result.

Good luck, and I hope this helps you make an informed decision about your surgery.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic Surgeon

Daniel Barrett, MD · Answer

Dear Loving334869,
based on your photos, it looks like you have a lot of extra skin so you will probably need FDL tummy tuck. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Arif Eroglu, MD · Answer

Hello; reverse abdominoplasty method, without sagging in the lower abdomen; in patients with excessive looseness in the upper abdomen field; is used. You have also sagging; there is excessive skin excess in both vertical and horizontal planes. Therefore, for you; Classic Abdominoplasty or Lipoabdominoplasty would not be suitable either. By the support of "Fleur De Lis" technique; surgery is required and needed as well.

Ronald J. Edelson, MD · Answer

Get the abdominoplasty done first.  A reverse tummy tuck may be helpful as Weill but I would hold off on that for a later time

Warren Schutte, MD · Answer

Congratulations on your successful weight loss. A panniculectomy removes the lower abdominal pannus of the abdomen. If you choose to do that through insurance, you will likely want more aesthetic refinement and skin excision in the future. If you forego the panniculectomy and plan for abdominoplasty first; you will likely want an abdominoplasty with lateral hip extension with vertical wedge (FDL).

Gary M. Horndeski, MD · Answer

Your breasts are quite low on the chest wall. I would recommend a breast lift first using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. This will also lift up the upper abdomen and may change the need for a tummy tuck. You may be able to get by with a circumferential body lift rather than a fleur de lis.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

The FDL will be much better and might be able to be done at the time of your panniculectomy, depending upon your insurance company. Some companies will not allow any elective procedure done at the same time.  You can discuss this with your surgeon.  I am not a fan of the reverse tummy tuck since it often pulls your breasts down.

Camille Cash, MD · Answer

Congratulations on your impressive weight loss!  From the submitted photos the best choice is the FDL approach.  This will allow your surgeon to address the maximum amount of excess tissue to give you the most sculpted result.  I've included a video that I hope you find helpful.

Gebal Matos, MD · Answer

Hi! Thanks for your question.
Given that most of the loose skin is located in the lower abdomen, I recommend undergoing a fleur-de-lis tummy tuck. This surgical procedure effectively removes excess fat and skin in that area, providing optimal results and a more defined abdominal contour. Always find a certified plastic surgeon, who can give you the best results.

FDL or reverse tummy tuck? (Photo)

Answers (13)

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