Two patients, two operations, one incision. From the outside the scar looks identical. Underneath, almost nothing is the same.
The Difference
“A panniculectomy is a procedure we perform as plastic surgeons with the objective of removing excess skin, improving hygiene, and improving function in patients that have lost considerable weight or have developed a considerable abdominal pannus. An abdominal pannus is a flap of skin that hangs over the mons area, folding over the abdominal fold. In a panniculectomy, we perform an incision that is very similar to an abdominoplasty, but we are only excising the overhanging skin in the lower abdomen. It does not affect the upper abdomen, or the abdominal muscle laxity or diastasis.”
The pannus is the apron. The mons is the pubic mound it hangs over. Diastasis is the gap between the two rectus muscles. A panniculectomy touches none of the upper abdomen and none of the muscle.
“In contrast, an abdominoplasty uses the same incision, but the skin and subcutaneous fat are undermined all the way up to the xiphoid and the costal margin to expose the abdominal muscles. The abdominal muscles are often plicated to correct diastasis and abdominal wall weakness, the excess skin is excised, and the umbilicus is repositioned. In an abdominoplasty there is overall improvement of the abdomen, including the upper abdomen, the lower abdomen, the waistline, and the abdominal laxity, and it improves the overall aesthetics of the patient.”
Undermined means lifted off the muscle. The xiphoid is the bottom of the breastbone, the costal margin is the lower edge of the ribs. Plicated means sewn tighter, the internal corset.
| Panniculectomy | Tummy tuck (abdominoplasty) | |
|---|---|---|
| Incision | Low, hip to hip | Same |
| What is removed | The overhanging apron only | Excess skin from the whole lower abdomen |
| Skin lifted to the ribs | No | Yes |
| Muscle repair | No | Yes, usually |
| Belly button moved | No | Yes |
| Objective | Hygiene, function, mobility | Shape, waistline, the whole abdomen |
Who Needs Which
“A panniculectomy is going to target different objectives, like hygiene, improved function, and improved mobility. In reality, if you consider this, it is more of a medical procedure than a cosmetic procedure. Although the patient will look better and feel better and fit better into their clothing, the objectives are more functional. We opt to perform a panniculectomy when the patient’s only concern is the overhanging pannus, or if the overhanging pannus is so large that it is really interfering with daily activities. It is really not going to change the shape or contour of the rest of the abdomen. But sometimes it may be the first step in a weight loss journey, which will ultimately culminate in a tummy tuck or circumferential body lift.”
“In contrast, a tummy tuck is performed to improve the overall aesthetic contours, and it targets the entire abdomen. In my hands, it is a 360 degree operation which also targets the lower back and the waistline. It is important to note that a person with an abdominal pannus could have an abdominoplasty after a consultation and identifying that they are a candidate.”
The first step, for the patient whose BMI is still high: I wrote about that line yesterday.
After Weight Loss or a GLP-1
“Patients considering a panniculectomy have often had massive weight loss, which was achieved with GLP-1s or bariatric procedures. These patients may be candidates for a panniculectomy or a tummy tuck, and really, how we choose between one and the other is going to have to do with the patient’s objectives. If they are mainly concerned with the overhanging skin, hygiene, and fitting into certain types of clothes, a panniculectomy may be all they need. But if a patient also wants to improve the upper abdomen, the waistline, and the back, then a tummy tuck may be the best procedure.”
Objectives. Not the scale, not the scar.
What Combines With What
“I would say that because a tummy tuck or abdominoplasty has a cosmetic objective, it is more likely to be combined with other procedures, including liposuction, fat transfer, chest or breast procedures, even thigh and arm work. When we perform a panniculectomy, it is mostly to improve function and hygiene, so a panniculectomy is most often performed alone, by itself.”
“Depending on the patient’s current BMI, a panniculectomy sometimes is combined with a mons lift or even a chest or breast reduction. The advantages of combining procedures is that there is just one anesthesia, one recovery, and oftentimes the cost of the procedures is less than if they were performed separately.”
Insurance, Honestly
“We do not work with insurance companies at the moment. Although panniculectomies can be covered through insurance if the patient meets certain qualifications, this is often that the pannus hangs over the mons, that there are recurrent infections or intertrigo in the abdominal fold, and that it has not responded to medical treatment.”
Intertrigo is the rash that lives in a skin fold. Those are the questions to ask your own carrier; I cannot answer them for you.
“We can perform a panniculectomy without insurance coverage through financing or other forms of payment. And if a patient wishes to have this procedure done by a physician that works with their insurance company, we would be more than happy to recommend someone.”
The longer version of why a cosmetic practice stays out of insurance is in my diastasis recti insurance gap read. Fees are posted at agulloplasticsurgery.com/fees, and the lipo and tummy tuck cost post walks through them. The surgical version of this post is on agulloplasticsurgery.com; the recovery-side version is on the Southwest Plastic Surgery post.
Why Choose Dr. Agullo
Double board-certified, by the American Board of Plastic Surgery and the American Board of Surgery. Mayo Clinic plastic surgery fellowship. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Castle Connolly Top Doctor for 13 consecutive years.
Ready to Talk?
Tell me your objective. I will tell you which operation it is. (915) 590-7900, text 1-866-814-0038, or book at agulloplasticsurgery.com/appointments. #StayBeautiful
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