September 3rd, 2013
After losing massive amounts of weight, getting rid of all the extra skin that is the final step in many of my patients' transformation into their "new self". There is a common perception that plastic surgery after massive weight loss is covered by most insurance plans. This article will describe what procedure is - and isn't - typically covered by insurance.
After bariatric surgery, many patients are told that insurance will cover the removal of all that extra skin by their bariatric surgeons, other physicians, or friends. This is true - sort of.
The procedure that insurance covers is what is known as a panniculectomy - removal of the pannus (the large amount of hanging skin on the front of the abdomen). What insurance will not cover is an abdominoplasty or tummy tuck. The question is: what is the difference? Many patients and other physicians think that the two procedures are essentially the same, but they are very different.
A panniculectomy is a procedure that takes about an hour and is usually done on an outpatient basis. It involves removing the excess skin in almost a straight line across the abdomen. In some cases, but not all, the belly button is removed. The waist is not narrowed and there is no "shaping" of the abdomen, waist, or thighs that is performed. Oftentimes, there is excess skin left in the flanks ("lovehandles") and upper abdomen.
In a tummy tuck or other body contouring procedure (body lift, etc) after massive weight loss, the excess skin is removed and every effort is made to hide the scar in normal clothing. The belly button is preserved and moved and the muscles of the abdomen are shaped. Many times, liposuction is added to help narrow the waist and add definition to the final result. This procedure takes about 3-4 hours, and, like a panniculectomy, is done as outpatient surgery.
So...which surgery is better: a panniculectomy or a tummy tuck?
That depends on your goals. A panniculectomy is a very good operation if your goal is simply to remove the excess skin to allow you to move more easily and eliminate rashes and sores that are sometimes caused by the pannus. If shape and "looking your best" are your goals, then a tummy tuck/body lift may be the choice for you. Those decisions are ones we can make after an in-depth consultation and examination - everyone's bodies are built differently and everyone has different goals for themselves.
In the end, a picture is worth a thousand words. Below are examples of both a panniculectomy and a tummy tuck so you can actually see what the difference is.