The Difference Between a Panniculectomy and a Tummy Tuck

Often, there is confusion about what is a pannus and what is a panniculectomy. Equally confusing, is “what is the difference between a panniculectomy and a tummy tuck?”. In this article, the difference between a tummy tuck and a panniculectomy is explained.

What is an abdominal pannus?

The abdominal pannus is the area of excess skin and fat that hangs over the pubic region. It is often described as an apron of residual abdominal skin and fat. Often, with weight gain and subsequent weight loss, there is an accumulation of residual fat in the lower abdomen. The accumulation of lower abdominal fat leads to stretching of the lower abdominal skin and can result in a collection of redundant lower abdominal skin and fat. Under the skin, one of the connective tissue adhesions of the body is of the lower abdomen to the supra-pubic region (or the top of the pelvis). This adhesion band and fat accumulation leads to the creation of this apron of skin and fat in the lower abdomen. This adhesion is the reason for the hammock-like distribution of fat from hip to hip in the lower abdomen.

What is a panniculectomy?

A panniculectomy is a surgical procedure that removes the abdominal pannus. During a panniculectomy, the pannus is removed. An incision is made underneath the lower abdominal skin apron and tissue dissection is carried upward. Dissection is carried upward for several inches until the pannus is encompassed. Usually, this is only 3 to 4 inches on the anterior abdominal wall. Then, the abdominal apron of skin and fat is removed. Drains are placed and the wound is closed in multiple layers. A panniculectomy is performed under general anesthesia with a anesthesiologist. Often, the panniculectomy is covered by your medical insurance. Recovery time for a panniculectomy is approximately 2 to 3 weeks before you can return to a sitting type job. If your job entails a lot more physical activity, your return to work is approximately 3 to 4 weeks.

Advantages of a panniculectomy include

1. Eradication of the apron of excess skin and fat above the pubic region.

2. Permanent elimination of rashes underneath the abdominal pannus.

3. Possible medical insurance coverage.

Disadvantages of a panniculectomy include

1. This is a reconstructive or functional surgery and is not a cosmetic procedure.

2. Although the apron is removed, the anterior abdominal muscular wall is not repaired. Therefore, even though you undergo a panniculectomy, you may still have a protuberant abdomen from the sternum to the pubic region after the procedure.

3. Compared to a tummy tuck, not as much skin is removed during a panniculectomy.

4. The umbilicus is unchanged and left in its original state.

5. No abdominal wall hernias can be repaired. The hernias would either have to be repaired in a second procedure or during an extension of the panniculectomy incision.

What is a tummy tuck?

During a tummy tuck, an incision is made in the lower abdomen where the abdominal skin overhangs the pubic region. Tissue dissection is carried to the belly button and then to the bottom of your rib cage and the bottom of your sternum. By undermined this area, all the attachments of the skin and fat to the underlying fascia (or the layer on top of the rectus abdominis muscle) are detached. This exposure allows access to the anterior abdominal wall or six-pack muscles. With weight gain or pregnancy, the rectus abdominis muscles and fascia are stretched. Unfortunately, the rectus abdominis muscles and fascia do not have elastic fibers. After weight loss or after pregnancy, the rectus muscle and fascia fibers cannot and do not bounce back. Often, patients are left with a distended abdomen after weight loss. This can be either due to weak abdominal fascia or a large peritoneal cavity. The peritoneal cavity is the body chamber below the rectus muscle and contains many of your digestive organs.

A tummy tuck entails three separate stages. During the first stage of a tummy tuck, after the anterior abdominal wall is exposed, two layers of permanent sutures are placed in the rectus muscle. One layer is placed as many single sutures from the sternum to the pubic region. A second layer of a running suture is placed on top of this layer to secure the bottom layer. On larger patients, muscle plication may be needed in a star-like fashion around the belly button. This is also done with permanent sutures. These muscle plication sutures tighten the rectus muscles and allow for flattening of the abdomen and making the peritoneal cavity smaller.

The second stage of the tummy tuck involves the permanent removal of excess abdominal skin and fat. Typically, skin from the top of the pubic region (or below a C-section scar) to the top of the belly button and even higher, can be permanently eliminated. By doing the aforementioned dissection and muscle plication, the skin and fat are loosened from their underlying fascial attachments. By removing these attachments, the skin above the belly button can be brought down to the pubic region. This rearrangement of abdominal tissue results in the permanent removal of excess skin and fat from the lower abdomen. The fascia and lower abdominal skin is then closed with sutures. Several drains are placed.

The third stage of the tummy tuck entails the repositioning of the belly button. Belly button repositioning is accomplished by making an incision on the new, anterior abdominal wall. The belly button is positioned in a vertical line drawn from the bottom of the sternum to the top of the dorsum of the penis or the clitoris. Another perpendicular line is drawn from the top of the iliac crest or hip bones. The intersection of these lines is where the belly button should be repositioned. A small stab incision is made and the belly button is presented and anchored.

Advantages of a tummy tuck include

1. Permanent plication and flattening of the abdominal wall.

2. Elimination of more skin and fat compared to the panniculectomy.

3. Reposition and recreation of a better looking belly button.

4. If present, surgical correction of anterior abdominal wall hernias.

5. A better cosmetic result compared to a panniculectomy.

Disadvantages of a tummy tuck include

1. Sometimes the tummy tuck scar may be longer than a panniculectomy scar.
2. Compared to a panniculectomy, the tummy tuck recovery may be longer.
3. The tummy tuck may not be covered by your medical insurance.

A tummy tuck is performed under general anesthesia with a anesthesiologist. Drains are kept in place for approximately 1 to 2 weeks. You should be able to return to a sitting type job at approximately 2 to 3 weeks. If your job is more physical, it may require 3 to 4 weeks before returning to work after a tummy tuck.

To qualify for medical insurance coverage for a panniculectomy or tummy tuck, you need to provide objective, documented chronic rashes. Documentation of rashes can include your personal or medical pictures and medical records from your trips for evaluation and treatment to your internist, dermatologist or plastic surgeon’s office. You should also provide documentation of medications including topical creams, antibiotics, and antifungal that you have tried over the years to correct these chronic skin infections. You will also need to document that the abdominal apron covers the pubic region. This can be achieved by taking pictures of the affected pannus. Also, most insurance companies require that your Body Mass Index (BMI) be less than 30. BMI is calculated based on your height and weight.

If you are considering a panniculectomy or tummy tuck or just need free advice, please contact Dr. J. Timothy Katzen to schedule a FREE consultation. Physical or virtual consultations can be arranged. Options include FaceTime, Zoom, Skye, or WhatsApp virtual consultations. Call Dr. Katzen TODAY for your FREE consultation to achieve the tummy of your dreams!!

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