Panniculectomy Vs. Abdominoplasty (Tummy Tuck): Understanding the Difference
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Many patients are confused about the difference between a tummy tuck, abdominoplasty, and panniculectomy.
All three of these are very similar operations. In fact, abdominoplasty is simply the medical term for the better-known tummy tuck. This procedure removes excess skin after undermining the abdominal wall and tightening and plicating the rectus sheath muscles.
What Is a Panniculectomy?
A panniculectomy is an enormous abdominoplasty, often called the removal of an abdominal pannus. This can occur after massive weight loss, such as in bariatric surgical or gastric bypass patients.
Patients who have lost well over 100 pounds often have a massive abdominal apron —or pannus — which is surgically removed with this procedure.
Usually, the abdominal wall is so diastatic and thin that suturing the wall is not feasible or appropriate.
Here, dissection is usually less aggressive superiorly up to the subcostal margin to maintain the blood supply of the flap down to the abdominal wall. The umbilicus is usually spared, but in some larger panniculectomies, it must be removed.
Panniculectomies are always performed under general anesthesia. Two or three Jackson-Pratt drain tubes will be placed to drain the fluid that accumulates after the flap dissection, and these will remain for at least 7 to 10 days after surgery.
In the enormous panniculectomies, Dr. Linder does not tighten the muscles internally. This is because the muscle will tear with these sutures, thus increasing the risk of bleeding while not affecting the final outcome.
Panniculectomies are a functional surgery. In fact, patients often have hygienic problems with dermatitis along the suprapubic region extending along the inguinal crease. They may also have lower back pain due to the massive amount of skin over-draping, which can drape all the way to the suprapubic region.
On the other hand, abdominoplasties are normally considered a cosmetic procedure because it involves the simple removal of tissue and skin with the tightening of the rectus sheath. Patients who undergo abdominoplasties normally have had one or more children, experienced large deliveries, or have had a mild to moderate amount of weight fluctuation.
Below are two short videos showing the pre-op markings of a panniculectomy and tummy tuck before surgery.
Pre-Op Marking for Panniculectomy Patient
This patient shows a massive amount of excess skin over the abdomen and hip area due to significant weight loss. This excess will be removed during a panniculectomy procedure.
During the surgery, muscles will be tightened, which may require a general surgeon to assist. The belly button will be recreated, and liposuction will be performed to help with enhancing body contouring. This functional and aesthetic operation will help alleviate heaviness while easing her current lower back issues.
Pre-Op Marking for Tummy Tuck Along With Rectus Muscle Repair
Due to having a few children, this patient has weakened or separated rectus muscles. This damage to the abdominal wall has caused her belly to protrude or bulge. Part of her tummy tuck procedure will involve having a general surgeon assist in tightening the rectus (for a corseted effect that will create a flatter stomach). She will also undergo liposuction of the hips, which will complement the patient’s new flat tummy.