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Abdominoplasty or tummy tuck is a cosmetic procedure that involves placement of horizontal lower abdominal and around the belly button incisions. The abdominal skin is then tightened by separating the skin and fat layer from the muscle layer, pulling down the upper edge of the incision and creating a new hole for the belly button higher up on the skin that has now been stretched downward. In most cases suture tightening of the abdominal muscles is also performed. In some cases additional tightening for very loose muscle is achieved by placing additional vertical and/or horizontal rows of sutures. The result is frequently improved by liposuction peformed at the same operation. It is not a medically necessary procedure and therefore not covered by health insurance unless the excess skin and/or fat is required to close an open wound or reconstruct a breast after breast cancer surgery rather than being removed for cosmetic reasons.
Panniculectomy is a lesser procedure that only involves removal of the lower abdominal skin without the muscle tightening or the upper abdominal skin tightening via around the belly button and lower abdominal incisions. The hanging fold of skin and fat is called a pannus so its removal is called a panniculectomy. The skin and fat are removed as a wedge without any lifting of the surround skin - fat from the underlying muscle layer. It would be medically necessary rather than cosmetic in nature if the removed skin has had recurrent infections or rashes (known as intertrigo) or is dead etc. In such cases the panniculectomy surgery is covered by health insurance. It is called a mini-tummy tuck when the excess skin and fat is slight and does not hang over the undergarment or genitalia when standing. Like a full abdominoplasty a mini-tummy tuck is a cosmetic procedure.
The pattern of removal as you can see in many cases results in removal of the belly button. Since the upper excision line is shorter than the lower excision line, especially when the skin-fat hang very low, a dart of skin has to be removed along the lower excision line in order for the 2 lines to match for closure.
Insurance coverage criteria for panniculectomy typically include:
- stable weight for 6 or more months
- photo documentation of skin and fat hanging over the pubic area
- medical record documentation of recurrent skin rashes and/or infections in the fold of hanging skin that does not respond to 3 or more months of topical and/or oral medications
Although panniculectomy can be performed in morbidly obese individuals abdominoplasty should not. The act of lifting skin-fat off the underlying muscle in abdominoplasty places these patients at a very high risk of complications. For these patients it is better to lose the weight surgically or non-surgically before undergoing an abdominoplasty.
Aaron Stone MD - twitter
Aaron Stone MD - Plastic Surgeon Los Angeles