Panniculectomy vs. Abdominoplasty
PANNICULECTOMY VS. ABDOMINOPLASTY (TUMMY TUCK)
Many patients are confused as to the terms, Tummy Tuck, Abdominoplasty, and Panniculectomy. In fact, all three of these are very similar operations. An Abdominoplasty and a Tummy Tuck are both the same operation in which skin is removed after significant undermining of the abdominal wall and tightening and plication of the rectus sheath muscles with permanent sutures. A Panniculectomy is an enormous abdominoplasty, often referred to as removal of an abdominal pannus. This can occur after massive weight loss such as bariatric surgical or gastric bypass patients. These patients who have lost well over 100 pounds, often have a massive abdominal apron or pannus which requires careful dissection and removal of the pannus. Usually the abdominal wall is so diastatic and so thin that suturing the wall is not feasible or appropriate. Paniculectomies are enormous abdominoplasties. The dissection is usually less aggressive superiorly up to the subcostal margin in order to maintain blood supply of the flap down to the abdominal wall. The umbilicus is usually spared, but in some circumstances must be removed in the larger paniculectomies. Paniculectomies are always performed under general anesthesia, two, if not three, Jackson-Pratt drain tubes will be placed in order to drain the fluid that accumulates after the flap dissection, for at least 7 to 10 days postoperative. In the enormous paniculectomies I do not tighten the muscles internally. This is instructed to the patients preoperative and that normally the muscle will tear with these sutures, increasing the risk for bleeding and not really greatly affecting the final outcome. Paniculectomies are a functional surgery. In fact, patients often have hygienic problems with as dermatitis along the suprapubic region extending along the inguinal creases bilaterally. They may also have lower back pain significantly due to the massive amount of skin over-draping, which can drape all the way to the suprapubic region.
Abdominoplasties on the other hand are normally considered a cosmetic or elective procedure in which again simple removal of tissue and skin with tightening of the rectus sheath is performed. Patients who undergo abdominoplasties normally have had one or more children, large deliveries or have had a mild to moderate amount of weight fluctuation.