Panniculectomy Vs Abdominoplasty

I've lost 154lbs after having a duodenal switch in August of 2009. I'm not 100% sold on the getting a tummy tuck rather than just a panni removal, I'd like a combination? I don't want to do just the panni removal since I have loose skin above the belly button, if the dr gives me a new belly button without tightening the muscle will I be happy with the result? I don't have weeks to take off work for recovery. I'm also considering having silicone BA at the same time. Thanks for any input.

Doctor Answers 21


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Congratulations on your weight loss!  Now the process of contouring your body to show the new you begins.  In my experience, massive weight loss patients achieve a better result with a full tummy tuck rather than a panniculectomy.  A panniculectomy will only remove the sagging skin below the navel while a tummy tuck addresses both the upper and lower abdomen.  A tummy tuck will tighten the upper and lower abdominal muscles as well as remove any sagging excess skin.  I routinely perform abdominal liposuction with a tummy tuck for extra contouring.  After a tummy tuck, you should be able to stand upright again after 2 weeks and return to strenuous activity in 4 to 6 weeks, and released with no restrictions at about 8 weeks.  Each patient heals differently so your recovery time could be shorter or it could be longer.  I typically recommend my tummy tuck patients take at least 2 weeks off for work.  After 2 weeks it is ok to return to work as long as there is nothing strenuous involved.  It is possible to perform a breast augmentation in conjunction with a tummy tuck as long as you are a low risk for anesthesia complications.  I recommend researching for a board certified plastic surgeon.  Then schedule a consultation for a thorough exam to find out which procedure is best to help you achieve your post weight loss body.

Be well and good luck!


Panniculectomy vs abdominoplasty

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Hello! Thank you for your question! I hope that these answers help! A panniculectomy is an excellent method for removing the excess skin and soft tissue of the lower abdomen (abdominal panniculus), often caused by weight loss. It is mainly performed to ameliorate symptoms caused by the abdominal apron such as hygiene issues, excoriations, rashes/infections, back pain, etc. A panniculectomy gives almost immediate relief from these issues as well as has been shown to stimulate additional weight loss as your activity level is increased after removal of the panniculus. An abdominoplasty is more of an aesthetic procedure in that as opposed to simply excising this excess tissue in a wedge to relieve complaints, an abdominoplasty focuses more on abdominal contouring, abdominal wall tightening, re-insetting the belly button, as well as often times the addition of liposuction.

I believe you would be better served by a full tummy tuck, in order to address your abdominal wall laxity as well as contouring of your flanks/hips, and upper abdomen. I would highly recommend continued diet and exercise prior to any consideration for a panniculectomy or body contouring as getting down to your ideal weight prior to the procedure will certainly give you the best results as well as be the safest for you. Neither one is a weight loss procedure. Also, a continued healthy and active lifestyle will be needed in order to maintain the benefits that the procedure has given to you. You should consult with a plastic surgeon at anytime to go over options and in order to assist you in deciding which procedure(s) would be right one for you. Best wishes for a wonderful result!

Body contouring (tummy tuck) after massive weight loss

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If you have lost over 150 lbs from a weight loss procedure, you may need more than a tummy tuck or a panniculectomy.  If you have significant loose skin of your upper/lower abdomen, back, sides and outer thighs, you may actually need a body lift to give you the best outcome.  This is difficult to answer without seeing photos of you or without examining you but most patients with that kind of weight loss will not be treated adequately with a tummy tuck alone.  This means you will likely require an incision that extends all the way around your back (like a belt) to address the loose skin and tissue of your sides and back. If you do have loose skin in those areas and only get a tummy tuck, this will leave you only "half" treated with your front looking good but your back and sides will not.

Although a body lift (circumferential tummy tuck) is a more involved procedure, I recommend consulting with a board certified plastic surgeon experienced in treating and contouring patients after massive weight loss.

Best wishes,


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A full tummy tuck may be better for you

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Congratulations on your weight loss! It is unfortunate that one of the side effects of massive weight loss is the development of a pannus (apron of skin). 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.

Differences Between Panniculectomy & Abdominoplasty

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It’s not unusual for massive weight loss patients to develop loose, saggy abdominal skin. This excess skin can cause a variety of functional problems including chronic rashes, infection, and back pain. In addition, loose abdominal skin may cause aesthetic deformities which effect self-esteem and self-image.

For these reasons, patients frequently seek corrective surgery following massive weight loss. When this situation arises, a variety of treatment options exist that address the skin, fat, and underlying muscles. These procedures are tailored to the patient’s specific anatomic findings and unique aesthetic goals.

In some cases, an abdominal panniculectomy can be performed. This procedure involves removal of excess lower abdominal skin. When this skin apron is removed, the umbilicus and underlying muscles are left alone. This procedure has a significant impact on function, but has aesthetic limitations. These include continued upper abdominal loose skin, pubic skin sag, and weak abdominal muscles.

For these reasons, it’s not unusual for patients to request abdominoplasty surgery. This procedure not only removes excess lower abdominal skin, but also removes excess upper abdominal skin and tightens the abdominal muscles as well. This procedure requires detachment of the umbilicus and transposition to a higher level. It’s associated with improved functional results and dramatically improved abdominal aesthetics. Unfortunately, tightening the abdominal muscles does occasionally prolong the recovery period.

It’s important to realize that each patient’s situation is unique. For this reason, it’s important to discuss your aesthetic goals with your plastic surgeon. Your plastic surgeon should be able to formulate a treatment plan that’s appropriate for your aesthetic goals and life style. In your case, it may not be appropriate to tighten your abdominal muscles. 

Tummy tuck versus panniculectomy

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Losing over 154lbs is a major accomplishment but it does leave you with loose skin and muscles.  The panniculectomy with removal of the overhanging loose skin will improve any problems with rubbing, rashes and wearing certain clothes but it does not tighten the muscles or improve loose skin above the umbilicus.  The advantage of tightening the core with muscle plication is tremendous and there is an overall improvement in the appearance of the abdomen with going above the umbilicus.  

The muscle tightening can add to the recovery time with added tightness or discomfort but not by much.  If you are going to undergo the procedure and deal with the recovery time, I would recommend getting the benefit of the tummy tuck for core strength and appearance.  If you are only interested in improving rashes or skin breakdown and wearing clothes better then the panniculectomy is a good choice.

Abdominoplasty indicated for most after massive weight loss

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The short answer is that if you are like the majority of my patients with massive weight loss you will do better with a combination of panniculectomy and tummy tuck (abdominoplasty).

Panniculectomy refers to simple excision, removal, of the roll, pannus, of redundant soft tissue in the lower abdomen which falls onto the thigh. Occasionally this procedure is covered by insurance if there is a documented recurrent or chronic infection and rash requiring medical treatment. It does not involve improvement to the mid or upper abdomen or tightening to the abdominal muscles, but can be done in conjunction with anAbdominoplasty which will accomplish these goals.
Abdominoplasty This procedure frees up all of the extra or redundant abdominal skin and fat by removing the excess skin around the abdomen and may be used to tighten the abdominal muscles. Liposuction often is used to lessen areas of the fat layer for an improved result. The procedure involves a side to side incision at the level of the pubic hair line. More sophisticated surgical approaches for Massive weight loss may include additional incisions such as a Fleur de lis, an additional incision in the midline up and down to remove excess skin from side to side (in addition to up and down tightening); a reverse lift leaving scars under the breasts, or a Pubic Lift for redundancy in the pubic region and other modifications that are customized to your particular needs. Because of the complexity and number of surgical options, it is key to choose your surgeon wisely. Make sure that he has experience in this type of surgery, is Board Certified by the American Board of Plastic Surgery. This is why so many of our patients choose Pacific Center for Plastic Surgery.

Tummy Tuck vs Panniculectomy

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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. See a board certified plastic surgeon.

Abdominoplasty vs panniculectomy

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When you loose that much weight i would go for the abdominoplasty.They are pretty much very similar in execution.Many times the muscles really don't have to be tightened and again your overall medical condition has to be taken into consideration when making a final decision.

PAnniculectomy vs tummy tuck

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If you do the panniculectomy without the tummy tuck you will get some improvement but most likely you will not be satisfied with it. You will have improvement but  the only tissue removed will be the skin and fat that hang below the umbilicus, there would be no tailoring of the tissue to make it tight.

You would have to take some time off but less than if you did the tummy tuck at the same time. In either case you would likely need a second operation in about a year to remove excess skin and improve the appearance.

You get what you pay for and you would most likely prefer the result of the full abdominoplasty at the time of the panniculectomy even with the time off and you more than likely would save some money if you did it at the same time.  

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.