Would it be best for me to have a full TT rather than an extended panniculectomy with vertical and horizontal incision? (photo)

Would it be best if I had the full TT? I have an abdominal hernia that my Dr will be doing a component separation repair and removal of the mesh from the last surgery from last September. The surgery left me with a large bulge in my tummy and lots of pain to this day. I'm 5'3 165lbs 34yrs

Doctor Answers 11

Abdominal wall hernia and tummy tuck surgery.

Thank you for your question.  It seems to me that your hernia has not been resolved as of yet.  While the best case scenario would be to  have an abdominoplasty with a combined hernia repair, this is not just a simple hernia.  As a result, I would recommend your hernia take front stage and be evaluated by a general surgeon and get their take on what they recommend.  They may tell you they can combine this with a tummy tuck performed by your plastic surgeon or should be its own surgery.  Once the hernia is definitively repaired, then aesthetic surgery may possibly be performed.  I hope this helps.

Bay Area Plastic Surgeon
4.9 out of 5 stars 111 reviews

Would it be best for me to have a full TT rather than an extended panniculectomy with vertical and horizontal incision? (photo)

Looking at your pictures: You have a significant skin overhang, stretch marks with moderate diastasis. I think a Full tummy tuck with liposuction to your hips and flanks will serve you best. You are a good candidate for this procedure already. Panniculectomy may not be sufficient to accomplish your goal.
In my opinion, I do not see a role for a vertical incision here. It will be too excessive with minimal, if any, benefit.

Maan Kattash, MD, FRCS, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 53 reviews

Should I have a full tummy tuck.

Thanks so much for your e-mail. I am still a little unclear on your past history.  If you have had a complicated hernia repair then this may have fundamentally changed the strength of your abdominal wall.  With that said it would be difficult to give you a solid recommendation without performing an exam and taking a detailed history.  

Shaun Parson, MD
Phoenix Plastic Surgeon
4.8 out of 5 stars 46 reviews

Would it be best for me to have a full TT rather than an extended panniculectomy with vertical and horizontal incision? (photo)

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.

Given your photo, it does appear that you have excess skin and soft tissue in both the horizontal and vertical directions, which would be well-served via excision.  However, only on physical examination would I be able to give my recommendations to you on this.  Regardless, a full tummy tuck would be a great option while you have your abdominal hernia repaired and abdominal wall reconstructed.  Your plastic surgeon can work directly with your general surgeon for incision planning as well as exposure.

I would highly recommend continued diet and exercise prior to any consideration for  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.  Best wishes for a wonderful result!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews


I agree with the other surgeons. Full abdominoplasy is the absolute single best option. The ONLY reason for you to "consider"  panniculectomy is if you are planning to have a baby. Even then, it would be best to have the baby first and subsequently, have a full abdominoplasy afterward.

Larry C. Leverett, MD, FACS
Phoenix Plastic Surgeon
4.7 out of 5 stars 17 reviews

Tummy tuck after abdominal surgeries

Your history is somewhat complex and certainly deserves thorough review along with a complete physical exam by a board certified plastic surgeon to make any firm recommendations!  Based on your picture, I believe you would most likely be a candidate for a full tummy tuck.  It sounds like your general surgeon has a plan for repairing the abdominal hernia and reinforcing the abdominal wall.  The remainder of the operation would involve removing the excess skin and fat from the lower abdomen, elevating and stretching the tissue from the upper abdomen down to the incision line and making  a new opening for the belly button.  Technically, the panniculectomy is just the removal of the excess skin and fat from the lower abdomen and would not involve a repair of the abdominal muscles and relocation of the belly button.  
All my best,

Clay Forsberg, MD

Clay Forsberg, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 15 reviews

Abdominoplasty versus extended panniculectomy

Thank you for including pics here.  The best option for surgery based upon the pictures provided is an abdominoplasty, in my opinion.  Unfortunately, a panniculectomy only addresses the excess skin and fat of the lower abdomen.  To address laxity in the fascia above the navel, a full abdominoplasty is required.  While this is an extensive surgery, abdominoplasty consistently ranks among the highest satisfaction of plastic surgical procedures.  Nothing substitutes for a good physical exam.  You should consider meeting with at least 2 plastic surgeons.

The best long term results are achieved when patients are the most well-informed.  Recovery may require 2 weeks or more.

Good luck!

Jason Hess, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 11 reviews

Would it be best for me to have a full TT rather than an extended panniculectomy with vertical and horizontal incision?

Thank you for the question and picture. Although “formal advice” would require in person consultation, most patients in your situation would much prefer the outcome associated with a full tummy tuck operation, as opposed to panniculectomy surgery. I think that repair of the significant abdominal wall diastasis, as well as any associated abdominal wall hernia, will leave you with an potential outstanding outcome after tummy tuck surgery. Make sure that you select your plastic surgeon carefully. Ask to see lots of examples of his/her work and communicative goals carefully as well. Since you considering undergoing a major operation which often involves a significant physical and emotional recovery ( often underestimated by surgeons and patients alike), a few words of advice may be helpful: 

1. Make sure you are doing the procedure for the right reasons (for yourself) and that you have realistic expectations. Be aware that an improvement in the “problem area” may not translate to an overall improvement in your life situation. You are bound to be disappointed with results of the procedure if your motivation for doing the surgery is not internally driven.
2. Time your surgery carefully; generally, it is not a good idea to have surgery done during or immediately after a stressful period in life (for example divorce or death of a loved one). The additional stress of surgery will undoubtedly be more challenging to deal with if a patient's emotional reserves our already exhausted. Remember, that an improvement in your physical appearance will not translate to an improvement in your life situation.
3. If possible speak to patients who have undergone similar procedures and query them about the toughest times of their recovery period. Any practical hints previous patients can provide may be very helpful.
4. Make sure you are aware of potential complications that may arise how to reach your surgeon if necessary.
5. Make sure you have a strong and patient support system (several people if possible) in place who have time/patience to take care of you. Arrange for professional nursing if any doubt exists regarding the availability and/or stamina of your caretakers.
6. Be patient with the healing process, understanding that it will take several weeks to months to feel “normal” again. It may also take many months/year to see the end results of your surgery.
7. Be prepared to distract your mind with things of interest such as books, magazines, and movies.
8. Expect less of yourself; do not go back to work, school or chores too early and let others take care of you (for a change).
9. Pick your surgeon carefully (a well experienced board-certified plastic surgeon) and trust in his/her advice. Keep in close communication with your surgeon and do not hesitate to communicate questions/concerns and the emotional swings that you may experience.
10. Resume all medications that you were using preoperatively when cleared by your plastic surgeon and stop the use of narcotics and sedatives as soon as feasible after surgery.
11. Keep in mind the end results as you go through the tougher emotional times after your surgery.
I hope this, and the attached link, helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,485 reviews

Lipo and TT

Thank you for the picture.

Based on the picture, you make a great candidate for an extended tummy tuck, this will actually tuck the front part and the sides as well. Liposuction in the waist, upper and lower back.

At my practice, these are very common surgeries. In all cases, they have been happy with results.

Dr. Campos

Jaime Campos Leon, MD
Mexico Plastic Surgeon
4.4 out of 5 stars 251 reviews

TT v. panniculectomy

The panniculectomy will, by definition, not address the excess skin problem in the upper abdomen. You would likely be left with excess upper abdominal skin and fat hanging over the navel. The full TT will give a superior outcome. 

All the best. 

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.