Can I have a panniculectomy done without an abdominoplasty? How will this affect my results? (photos)

Question

Was approved for a Panniculectomy, deciding on if the abdominalplasty is something that I have to do along with it or how much it would hinder my results if I opted out of that?

J. Timothy Katzen, MD, FACS · Answer

Hello Fifi15, Thank you for your question regarding whether you can have a panniculectomy done without an abdominoplasty and how it will affect your results? 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 “tablecloth” 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 type of pannus throughout the body (eyes, joints etc.).  In your case, the pannus refers to the apron of skin, which 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 word for a tummy tuck.  The word abdominoplasty is a combined word which comes from the Latin word “abdomin” (the word for abdomen) and the Greek word “-plastia” (the word which means "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 (FD) tummy tuck, mini tummy tuck, reverse tummy tuck, and the lateral tummy tuck. Different tummy tucks are indicated for different anatomic 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 plicated 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 is removed from the hanging pannus.  However, the similarity between a panniculectomy, and abdominoplasty pretty much end there. An abdominoplasty is a much more invasive procedure with (in general) much better and superior results compared to a panniculectomy. In addition, during a tummy tuck, the belly button is repositioned and given a better appearance. Also, the abdominoplasty is much more superior than 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. In addition, liposuction is usually performed 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 the panniculectomy; however, unfortunately, not all insurance companies approve the panniculectomy. Usually, for your insurance company to cover and pay for a panniculectomy, you need to meet the following criteria: 1) your abdominal pannus must hang below level of pubis or pelvic bone 2) if you lost more than 100+ lbs with diet and exercise, you must be at a stable weight for 6 months. If you lost more than 100+ lbs with weight loss surgery, then your weight must be stable for 18 months 3) you must have a documented history (in doctor’s office) of recurrent rashes or non-healing ulcers that are not respondent to antibiotic, antifungal, or steroid creams and 4) you must have documented difficulty with ambulation or interference with activities of daily living.   A panniculectomy solely performed for the correction of low-back pain is considered NOT medically necessary and usually not covered.  
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 remove the pannus and an abdominoplasty address is the entire abdominal wall, and typically, delivers far superior results compared to a panniculectomy.   Thank you for your question regarding
I specialize in reconstructive plastic surgery after weight loss.  If you have any more questions regarding the panniculectomy, traditional low horizontal tummy tuck, extended tummy tuck, high lateral tension tummy tuck, vertical tummy tuck, inverted T or fleur-de-lis (FD) tummy tuck, mini tummy tuck, reverse tummy tuck, and the lateral tummy tuck, please contact my office. Since the panniculectomy or lower body lift is a big procedure, please seek an experienced, board certified plastic surgeon with significant experience performing the panniculectomy or lower body lift. Do your research.  Make sure they have performed at least 100 panniculectomies or circumferential lower body lift surgeries and have the 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 neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” 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.)

Camille Cash, MD · Answer

To help make your decision it's helpful to know the differences between the two procedures.  A panniculectomy will remove the hanging skin from your abdomen.  It will not address loose skin at the front of the abdomen nor contour the abdomen.  A tummy tuck can address the loose hanging skin as well as correct abdominal wall laxity and separation.  It can also address the loose skin of the central abdomen. The result is a flatter, tighter tummy.

Adam Kinal, MD · Answer

Dear Chachierb, Thank you for including photographs with your question. However, giving a proper assessment with an in-person examination is easier. Don't hesitate to contact several Board Certified Surgeons who specialize in these procedures to get their evaluation. Panniculectomy is a procedure that can certainly get rid of 'the apron' of tissue, but you may need more than that. A few types of tummy tuck procedures may suit you better. Still, it is advised to seek an in-person evaluation with an experienced surgeon specializing in these procedures. Good luck. Dr. Adam Kinal

Zoran Potparic, MD · Answer

Panniculectomy is a conservative form of abdominoplasty where sagging skin pannus is directly removed with skin and fat content, without doing more agressive skin flap elevation and tightening to avoid complications like skin necrosis, fat necrosis, seroma, wound separation and similar. That procedure would create very nice improvement in your case providing that it is done by a board certified plasytic surgeon. Good luck.

Daniel Barrett, MD · Answer

Dear chachierb,
it is hard to tell for sure without an examination. 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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

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Can I have a panniculectomy done without an abdominoplasty? How will this affect my results? (photos)

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