A tummy tuck removes extra skin and fat (pannus) from your belly but also reshapes the muscles. A panniculectomy only removes the pannus — it doesn't reshape your stomach.
“A tummy tuck is purely cosmetic, while a panniculectomy is often needed for medical reasons,” says Scott Hollenbeck, MD, president of the American Society of Plastic Surgery and chair of the Department of Plastic and Maxillofacial Surgery at the University of Virginia.
Maybe you’ve given birth and want your pre-kid body back. Or perhaps you lost weight and the skin sags around your tummy. Whatever the reason, it’s normal to want to freshen up your belly area.
Neither surgery can help you lose weight. But a panniculectomy can help you manage extra skin. And a tummy tuck can help you change your stomach's look. Find out how these two surgeries are different and which one is right for your health.
Panniculectomy vs. Tummy Tuck
Both surgeries remove extra skin below your belly button. The extra skin is called a pannus or apron.
Panniculectomy removes the extra skin for medical reasons. And abdominoplasty, or a “tummy tuck," can reshape your abdominal muscles. It's done for cosmetic reasons.
What is a panniculectomy?
A panniculectomy is surgery to remove hanging skin and fat from your lower abdomen.
“It literally means removal of pannus, an apron of skin and fat that hangs over the beltline, sometimes down to the thighs and knees,” says Hollenbeck.
Unlike a tummy tuck, a panniculectomy doesn't tighten your abdominal muscles. And the surgery is often done with another procedure, like hernia repair.
What is a tummy tuck?
A tummy tuck removes your pannus but also tightens weakened muscles. It can reshape your belly to create a tight, taut abdominal area.
“The surgery may also repair diastasis, or separated abdominal muscles,” says Hollenbeck. The surgery often includes liposuction, but not always.
Who Might Get a Panniculectomy or a Tummy Tuck?
You may consider a panniculectomy or tummy tuck for cosmetic or overall health reasons.
Why do people want a panniculectomy?
Most of the time, people get a panniculectomy after weight loss. “It’s usually done for medical reasons, such as a chronic skin rash and skin infections,” Hollenbeck says. The hanging skin can make peeing and cleaning the area harder, too.
With medical skin changes, you can get:
- Infections like yeast
- Dermatitis, a skin rash
- Lymphedema, a fluid buildup leading to infection and ulcers
Why do people want tummy tuck surgery?
The most common reason for tummy tuck surgery is to repair your stomach muscles after childbirth, says Hollenbeck. “That’s why it’s often known as a mommy makeover, especially if it’s done with a breast lift,” he says.
But you may get a tummy tuck if you have:
- Lost a lot of weight
- Loose, saggy belly skin from aging or sun damage
- Weight fluctuations
- Abdominal surgery from a C-section or pregnancy
But the surgery can also repair belly bulge (rectus diastasis) after your stomach muscles get separated. And it can also tighten connective tissues (fascia) to fix stretch marks.
Panniculectomy vs. Tummy Tuck Procedure Explained
You get general anesthesia through an IV in your vein with both surgeries. You'll be asleep and won't feel anything. But “a panniculectomy is often more intense," says Hollenbeck. "Sometimes up to 50 pounds of extra skin and fat are removed."
A panniculectomy can take one to two hours. Your surgeon may:
- Make a horizontal cut (incision) between your pubic hairline and belly button.
- Make another cut to remove extra skin near your hip. It depends on how much skin your surgeon needs to take out.
- Take out your upper belly skin and pull the remaining skin down. This helps them remove any extra skin, and if needed, remove your belly button.
- Make a new opening for your belly button and pop it into place.
- Pull the skin together to sew it closed.
You may have a small drain (a tube) in your belly. They'll remove it later. Panniculectomy can be done as an outpatient. But you may stay one to two days in the hospital.
A tummy tuck can take two to four hours. Your surgeon will:
- Make a small cut to begin liposuction, if it's part of your procedure.
- Check the markings on your tummy before making cuts above your pubic bone.
- Remove extra skin and fatty tissue, moving toward your rib cage.
- Lengthen the cut to remove any loose skin near your back — also called a circumferential abdominoplasty.
- Take time to repair any weakened stomach muscles.
- With a complete tummy tuck, make a new opening for your belly button and pop it in. But if you're getting a partial (mini) tummy tuck, you'll skip this step.
They'll remove the small drainage tube later. Your surgery may be done as an outpatient. But some people stay one night in the hospital, too. It can depend on the type of tummy tuck.
How much do you have to weigh to get a panniculectomy or tummy tuck surgery?
You don't have to weigh a certain amount to get a panniculectomy or tummy tuck. But most doctors suggest that your weight be stable before surgery.
That's because your new body shape is often permanent — as long as you maintain your weight. Weight gain or loss can impact your results.
“For a panniculectomy to be covered by insurance, we need to take preoperative photos to show what’s going on,” says Hollenbeck. “If skin hangs to your mid thighs or you have a history of skin infections in the area, it’s usually persuasive enough to convince your health insurance that it’s medically necessary.”
What to Expect After a Panniculectomy or Tummy Tuck Surgery
You'll focus on healing for the first few weeks after surgery.
To help yourself recover, you can:
Take it easy. Be careful when you move around. Don't lift or strain your belly too much. And try not to put pressure on your cut.
Don't bend or stretch. Talk to your doctor or nurse about how to move safely. Until your cut heals, bending at your waist may reopen your wound. Try to keep your cut from stretching — ask for help or use a grabber to pick objects up.
Avoid exercise.For the first eight weeks, avoid sports and strenuous activity. Talk to your doctor about when you can be active again.
Wear your compression bandage. Wear your compression bandage for six to eight weeks. The belly binder can help prevent any fluid buildup.
Elevate your bed. Talk to your doctor about raising the head of your bed. Elevating your bed at least 30 degrees can keep swelling down.
Take your medications. Set a reminder to take your medications as directed. They can help with pain, thin your blood, or prevent infection. This can help you heal faster.
Your surgery scars usually fade after several months to a year. And many people return to work after four weeks. But it can depend on the type of work you do.
After a tummy tuck
After you heal, you’ll most likely be happy with your surgery. A tummy tuck can often help more than a panniculectomy. It removes extra skin and fat.
But the surgery also reshapes your belly. Your tummy can look flatter, more taut. That's because your stomach muscles are tighter.
After a panniculectomy
With panniculectomy, you won’t notice a toned or more defined waistline, says Hollenbeck. The extra skin and fat hanging over your tummy will be gone. But if you had a “pooch” before surgery, you'll still have it afterwards.
You may also feel a pulling, but this goes away as you heal. After six weeks, you may still have some bruising and pain. It can take up to six months to fully recover from panniculectomy.
What's the Price Difference Between a Tummy Tuck and a Panniculectomy?
The American Society of Plastic Surgeons report the average tummy tuck costs $8,174 in the U.S.
A tummy tuck, with insurance covering panniculectomy, costs about $9,000 in Boston. But by itself, it costs $10,500 to $12,000. The difference is liposuction costs more.
And the price doesn’t include other surgery costs, like:
- Anesthesia
- Use of hospital or surgical room
- Blood tests
- Prescription medications
- Post-surgery clothing
Many health insurance policies don't cover tummy tucks. “When you factor in all these other costs, you can easily spend 20-25K out of pocket,” says Hollenbeck.
Many plastic surgeons offer patient financing plans. The plans allow you to pay a little bit at a time. So you don't have to pay the full amount at once.
And panniculectomy can cost more. That's because it’s a more complex procedure, says Hollenbeck. Although it's often covered by health insurance, you’ll still pay out-of-pocket, deductible, and copay costs.
How to Know Which Procedure to Choose
A tummy tuck may be right for you if you have:
- Loose belly skin (from weight loss or pregnancy)
- Separation of your abdominal muscles (from past surgery or pregnancy)
- Fatty tissue and belly skin not going away with diet and exercise
But a panniculectomy is better to remove extra skin from weight loss or pregnancy.
Sometimes, people opt for both, says Hollenbeck. It’s best to meet with a board-certified plastic surgeon. They’ll help you decide which one to choose.
Are There Risks to These Surgeries?
Just like any surgery, these procedures have risks. In fact, after tummy tuck, almost 10 out of every 100 people get complications. But 21 in 100 people get complications after panniculectomy.
After surgery, you can get:
- Blood collection outside of your blood vessel (hematoma)
- Infection
- Blood clots
- Pain
- Scars
Tummy tucks are often combined with liposuction and breast lifts. And research suggests combining procedures can raise your risk.
With tummy tuck, you can get:
Parts of your lung not inflating (collapse)
Tissue injury caused by fluid buildup under your skin (seroma)
Tissue damage during the surgery (smoking raises your risk)
With panniculectomy, you can get:
Numbness
Imbalance in your stomach (asymmetric)
Loose skin again
Healing problems
Can you gain weight after a panniculectomy or a tummy tuck?
If you gain a few pounds, it probably won’t impact your results, says Hollenbeck. But if you gain more than 10 or 15 pounds, it change your belly shape.
Most surgeons suggest that you be near your target weight for at least six months before your surgery. You may also want to be done with having children. Another pregnancy can stretch your abdominal muscles.
When to call the doctor
Some symptoms after surgery need treatment right away. Call 911 or go to your local emergency room if you get:
- Serious pain
- Bleeding that won't stop
- Swelling
- Fluid or pus coming from your cut (incision)
- Abnormal heartbeat
- Shortness of breath
- Pain in your chest
Takeaways
Both a panniculectomy and a tummy tuck remove extra skin from your belly. A tummy tuck cosmetically repairs the muscles but isn’t covered by insurance. Because panniculectomy is medically needed, insurance often covers it. Talk to your surgeon about the best option for your health.
Panniculectomy vs. Tummy Tuck FAQs
Does panniculectomy include FUPA?
No, panniculectomy doesn't usually remove your fatty upper pubic area (FUPA), says Hollenbeck. A surgery called monsplasty uses liposuction to remove fat from your upper pubic area.
What disqualifies you for a panniculectomy or a tummy tuck?
If you're pregnant or have certain untreated medical conditions, surgery may not be the best option.
Your surgeon may also suggest waiting if you:
- Plan to get pregnant again
- Are still losing weight or working to improve your health
- In the process of quitting tobacco
- Have a long history of problems with surgery
How long does it take to be approved for a panniculectomy?
Once you’ve met with your plastic surgeon, you can schedule your panniculectomy right away, says Hollenbeck. Your insurance company usually takes about a month to approve your surgery. But it can depend on your insurance, too.
How do you get skin removal surgery approved by insurance?
Your insurance may approve skin removal if you have:
- Lost at least 75 pounds
- A BMI is less than 30
- Been at the same weight for at least three to six months
- A history of skin rashes or infections from your hanging skin
- A hard time moving around because of the extra skin
And approval is more likely if all of these are true.
