Abdominoplasty or panniculectomy: Choosing the right procedure for your tummy

For so many patients, both women and men, one of their "problem areas" is the abdomen. Whether coping with a new postpartum body, trying to combat stubborn belly fat or addressing loose skin from drastic weight loss, there are plenty of reasons to pursue cosmetic changes.

Plastic surgery patients who have concerns about their tummy may opt for an abdominoplasty, more commonly known as a tummy tuck, or a panniculectomy. Both procedures focus on the belly, but they each have several key differences in terms of how they are performed, the results that can be achieved and the patients for whom they are best suited.

So, how do you choose the right procedure to address your unique concerns? Is there anything potential patients should know before they opt for either procedure? To better understand the difference between these procedures, we reached out to ASPS Member Surgeon Orlando Llorente, MD, for a Q&A.

ASPS: With many patients, one of the primary problem areas that they seek out to address with plastic surgery is the abdomen. Two procedures that can address the aesthetic appearance of the abdomen are abdominoplasty and panniculectomy. How popular are these procedures at your practice?

Dr. Llorente: I have been in practice about 15 years, mostly in private practice, and have dedicated most of my practice to cosmetic surgery. Abdominoplasty is one of the top three procedures I perform. Sometimes, it is just abdominoplasty, and other times, it is a combined procedure such as a mommy makeover, which usually incorporates addressing the aesthetic appearance of the breasts as well. Abdominoplasty is definitely a fairly popular cosmetic procedure in my practice.

Panniculectomy is somewhat different, in that it is the removal of a panniculus or a pannus, a type of apron of skin and subcutaneous tissue that hangs below and covers the pubic area. These patients sometimes have more of a mobility problem or a hygiene problem. By removing that extra skin, it helps them not only in a cosmetic way, but in a functional way as well.

ASPS: Are there any key differences in patients that you see and their goals for abdominoplasty vs panniculectomy?

Dr. Llorente: In my practice, the abdominoplasty patients are predominantly female, postpartum and are very much interested in improving the cosmetic appearance of their anterior (front) abdomen. These patients have an excess of skin or loose skin and usually some diastasis (separation) of their abdominal muscles.

Panniculectomy patients tend to be massive weight loss patients that are not candidates for an abdominoplasty, in a sense that they're limited to excess of skin. It can also be some obese individuals that aren't candidates for abdominoplasty. Sometimes, they have either previous surgeries or scars that inhibit the extent of what an abdominoplasty can do. Sometimes, these patients are a little bit tricker and not necessarily looking for an aesthetic outcome.

ASPS: What are the inherent differences and commonalities in how these procedures are performed?

Dr. Llorente: In general, they both consist of a transverse abdominal incision (a surgical cut made horizontally across the abdomen), usually at the interface between the pubic area and the anterior abdomen. The length varies, but it's usually waist to waist, side to side. They both remove excess skin below the umbilicus (belly button).

The procedures themselves are very different as well. Abdominoplasty usually involves tightening of the muscles and repair of the diastasis, whereas a panniculectomy does not touch the muscles – rather, it involves removal of extra skin. Additionally, the panniculectomy does not involve shaping a new belly button or muscle repair.

ASPS: How are these procedures alike and different in terms of the recovery process?

Dr. Llorente: In my practice, they are very similar during the recovery process in the sense that I do place drains. The recovery, realistically, is about two weeks for both procedures, with restrictions of lifting and movement for approximately six weeks.

The abdominoplasty that involves muscle tightening can be a little bit more uncomfortable initially due to the tightening of the muscle, whereas the panniculectomy is just removing skin. Some panniculectomy patients do have more comorbidities (presence of two or more diseases) such as diabetes or mobility issues, so they may be a little more at risk of developing a complication post-procedure.

ASPS: Do you have any advice or best practices for patients who are interested in pursuing either of these procedures?

Dr. Llorente: I think in general, good candidates for either procedure should be as close to their ideal body weight as possible beforehand. Additionally, any type of comorbidity should be well-controlled.

For an abdominoplasty patient who is seeking the procedure postpartum, they should ideally be done with future pregnancies. You do not want to perform an abdominoplasty on a patient and then they have another pregnancy. This would possibly stretch out all of their muscle repair and ruin the result of the original abdominoplasty.

ASPS: Are there any other insights around this topic that you'd like to share?

Dr. Llorente: I think as plastic surgeons, we should pay much more attention to reconstructing the new belly button in abdominoplasty procedures. This is a focal point in the procedure, and a lot of surgeons miss the boat on recreating a natural-looking belly button. That's the biggest thing that a lot of patients are hesitant about with a tummy tuck.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.