Panniculectomy or tummy tuck? (Photo)

Question

Hi, I'm a 31 year old. I've had 3 kids and I had one c section. It's been 7 years since my c section and my stomach gets worse every year. It protrudes and I look pregnant all of the time. I have insurance and was thinking about asking my primary about a referral for a panniculectomy. I heard it's difficult for insurance to cover this procedure. My issues are bloating, over hang, my clothes do not fit and no matter how much I exercise my stomach just sags and bloats and overhangs when I sit.

Leila Kasrai, MD, FRCSC · Answer

While you do appear to have a bit of overhanging skin/fat, a panniculectomy may not be warranted. A full tummy tuck may be more suitable for you. However, this would only remove the fat that’s subcutaneous and not deeper (visceral). For this reason, it may be a good idea to consider losing some weight first to achieve a mores satisfying result from a tummy tuck.

Andrew Ray, DO · Answer

The big thing looking at your pictures is that you would benefit from muscle repair and skin restricting. you do not have a big pannus. A panniculectomy only includes removal of hanging skin without reposition of belly button or repair of muscles. This is different than a tummy tuck which should include repair of muscles, reposition of your belly button and restructing your skin to drape better over your abdomen.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question and for sharing your photos. Based on your photos, I would recommend that you lose some weight before considering a tummy tuck or panniculectomy to achieve the best possible results. You appear to have both subcutaneous and visceral fat, and while subcutaneous fat can be addressed through surgery, visceral fat (fat around your internal organs) can only be reduced through weight loss, as no surgical procedures target visceral fat.

I suggest discussing new weight loss medications like Ozempic or Wegovy with your doctor, as these can be highly effective in helping with weight loss when lifestyle changes alone aren’t enough.

Additionally, from a medical perspective, you may not be deemed eligible for a panniculectomy by insurance since your tummy apron does not fully cover your pubic region when standing. A panniculectomy is typically covered by insurance when it is medically necessary, usually due to chronic rashes, infections, or functional issues caused by the skin overhanging the pubic region.

Once you lose weight, I would recommend opting for a tummy tuck over a panniculectomy. The tummy tuck provides several key advantages:

It not only removes excess skin and fat but also includes muscle repair to correct abdominal separation (diastasis recti), giving you a flatter and tighter abdominal profile.
A tummy tuck improves the contour of both the upper and lower abdomen, while a panniculectomy only addresses the skin overhang in the lower abdomen and doesn't address muscle separation or provide as much aesthetic improvement.
With a tummy tuck, your belly button is repositioned, and the skin is redraped for a smoother, more natural appearance.
In summary, losing weight first will help you achieve better results with surgery, and when the time comes, a tummy tuck will offer more comprehensive results compared to a panniculectomy.

Sincerely,
Dr. Katzen

Azita Madjidi, MD, MS, FACS · Answer

It depends what you are looking for. If you just want to get rid of the skin roll in the bottom, then all you need is to remove that, with a panniculectomy. However, the amount of skin does not justify medical necessity, therefore it will be a cosmetic procedure. 
If your goal is to have flatter stomach and improved abdominal shape and you are done having children, then you would need a tummy tuck to have the best result.
In wither case you need to also work on weight loss and exercising to have the best result you can have.

Camille Cash, MD · Answer

From the photos the tummy tuck is the procedure that would most help you.  A panniculectomy will only remove the apron of overhanging skin.  From your description you would benefit from abdominal wall correction as well as excess skin and subcutaneous fat removal.  Visit with a board certified plastic surgeon near you to learn more.

Andrew T. Cohen, MD, FACS · Answer

i would say a tummy tuck but important to be seen for an in person exam with a board certified plastic surgeon. Panniculectomy is for patients that don't want to look better. It just resects the lower abdominal skin but the result is not optimal. Do a tummy tuck to get the best contour and aesthetic to your abdomen.

Best to see a board certified plastic surgeon.
Good luck!

Andrew Cohen, MD

Best to see a board certified plastic surgeon. 
Good luck!

Andrew Cohen,  MD

Panniculectomy or tummy tuck? (Photo)

Answers (6)

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