Pandectomy Due to 100 Lb Weight Loss - Will Doctor Tighten Abs?

Hi Piggy52,
Thank you for your question regarding will the doctor tighen abs during a panniculectomy due to a 100 lb weight loss. The answer is "no". If your plastic surgeon is performing a panniculectomy, by definition, the rectus abdominis is not tightened or sewn together. If your plastic surgeon sutures the muscles together, the procedure is no longer called a panniculectomy.
Let’s examine the difference between a panniculectomy and abdominoplasty. Let’s examine what the word "panniculectomy" means. A panniculectomy is a combination of two words. First, the word “pannus” is derived from the Latin word for “apron” and refers to a hanging flap of tissue. Second “-ectomy” comes from the Greek word “ektome” which means cutting out or removing. Therefore, a panniculectomy is a surgical removal of the pannus. There can be many different types of pannus throughout the body (eyes, joints, etc.). In your case, the pannus refers to the apron of skin that hangs over the pubic region.
Technically, a panniculectomy ONLY involves the removal of the pannus. A panniculectomy does NOT include raising or reducing the pubic region. A panniculectomy does NOT involve any manipulation of the umbilicus (belly button), and does NOT involve muscle tightening (rectus abdominis plication, or rectus diastasis/separation correction) or liposuction. Let’s now examine what a tummy tuck includes. An abdominoplasty is the medical term for a tummy tuck. The word abdominoplasty is a combined word that comes from the Latin word “abdomin” (meaning “abdomen”) and the Greek word “-plastia” (meaning "to form" or “to mold”). There are eight different types of tummy tucks. There is the traditional low horizontal tummy tuck, extended tummy tuck, high lateral tension tummy tuck, vertical tummy tuck, inverted T or fleur-de-lis (FDL) tummy tuck, mini tummy tuck, reverse tummy tuck, and the lateral tummy tuck. Different types of tummy tucks are indicated for various anatomical problems. In your case, I would suggest the low horizontal tummy tuck. During an abdominoplasty, an incision is made underneath the pannus, and dissection is made to the sternum or rib cage. The rectus abdominis muscle is plicate,d giving you a much flatter stomach on profile compared to a panniculectomy. In your case, the tummy tuck would be similar to the panniculectomy in that an incision is made underneath the abdominal pannus. In addition, the panniculectomy is similar to the abdominoplasty in that excess skin and fat are removed from the hanging pannus. However, the similarity between a panniculectomy and abdominoplasty pretty much ends there. An abdominoplasty is a much more invasive procedure with (in general) much better and superior results compared to a panniculectomy. Additionally, during a tummy tuck, the belly button is repositioned and given a more aesthetically pleasing appearance. Also, the abdominoplasty is much superior to the panniculectomy because more skin and fat can be removed during a tummy tuck than a panniculectomy. Typically, excess skin and fat from the top of the pubic region to above the belly button is removed. Remember, during a panniculectomy, only the skin and fat from the pubic region to the top of the hanging pannus is removed. Additionally, liposuction is often performed in conjunction with a tummy tuck. In general, for almost all patients, a tummy tuck or abdominoplasty is far superior and a panniculectomy. Many insurance companies approve panniculectomy; however, unfortunately, not all insurance companies do. If I were you, I would opt for the tummy tuck rather than the panniculectomy—even if that means paying more money. I hope this helps answer your questions regarding the difference between a panniculectomy and an abdominoplasty. Remember, in general, a panniculectomy only removes the pannus, while an abdominoplasty addresses the entire abdominal wall and typically delivers far superior results compared 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 significant procedure, please seek an experienced, board-certified plastic surgeon with extensive experience performing these procedures. Do your research. Ensure they have performed at least 100 panniculectomies or circumferential lower body lift surgeries and have the corresponding 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 surgeon in your area, consider traveling out of state if necessary. 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.)

It’s not unusual for patients to develop significant
amounts of redundant abdominal tissue following massive weight loss. When this
situation arises, a variety of surgical options are available for treating this
condition. The procedure chosen is dependent upon the patient’s anatomic
findings and specific aesthetic goals. Massive weight loss is accompanied by
significant anatomic changes. Not only do patients develop large amounts of
redundant abdominal skin, but changes occur in the underlying muscles as well.
In most cases, these muscles have been stretched and weakened. These changes
are often accompanied by a midline separation known as a diastasis and occasionally
the development of hernias.

When a patient undergoes abdominal panniculectomy, the
procedure is often tailored to meet the patient’s specific needs. When the
underlying abdominal muscles have undergone changes associated with weight
loss, it’s appropriate to tighten and repair them. This is often a decision
that’s made in the operating room under direct visualization.

This decision not only involves aesthetic considerations
but safety considerations as well. It’s important to realize that tightening the
abdominal muscle can lead to respiratory insufficiency in some cases. For this
reason, it may not be appropriate to tighten the muscles in these cases.

If you’re concerned about weakness of the underlying
abdominal muscles, it’s important to discuss the
management of this issue with your plastic surgeon. Your surgeon should be able
to formulate a treatment plan that addresses your concerns.  

A panniculectomy will only remove the excess skin and fat that is forming the apron of skin, and won't do anything for anything above this. That's why a tummy tuck would probably be better for you. Muscle tightening will not be performed unless you request it.

Tummy tuck is mainly to improve shape and contour by plicating your core tight then re-draping the skin. Without the core tightening (muscle repair), its not a tummy tuck, but a panniculectomy (skin and fat resection). Massive weight loss almost always requires tightening of your core but if approved fro a panniculectomy only then core will not be tightend by PS.. See a board certified plastic surgeon.