Abdominal Panniculectomy

Q: Dr. Eppley, I am interested in getting a tummy tuck but don’t know too much about it. What type of tummy tuck do I need? Should I try and lose more weight before? Although with my back injury and being on disability I don’t see any significant weight loss happening. I have attached some pictures of my overhanging stomach for your review.

Abdominal Panniculectomy result side view Dr Barry Eppley IndianapolisA: Thank you for sending your pictures. What you have is a large abdominal pannus and thick abdominal tissues. What you would ultimately need is really an abdominal panniculectomy rather than a classic tummy yuck. Your abdominal tissues are too thick an your weight is too high to do accomplish anything more than an extended abdominal panniculectomy. While such a procedure would clearly have great benefit, ideally you should lose a lot more weight to have the better abdominal reshaping procedure. But for many patients weight loss is difficult and an abdominal panniculectomy now is better than nothing at all. That would have to be a decision that only you can make and I think with your back injury that decision has already been made.

You should clearly understand that an abdominal panniculectomy is not the same as a tummy tuck. It is a less refined although larger amount of abdominal tissue removal whose main objective is to eliminate the overhanging abdominal tissues.

Dr. Barry Eppley
Indianapolis, Indiana

Tummy Tuck

Q: Dr. Eppley, I am interested in getting a tummy tuck later this year. I work out five days a week lifting weights and  and eat a high protein based diet. I am 220 pounds and 6’ 2” feet tall.mI am trying to get down to 10 percent body fat and stabilize at 190 pounds. My trainer predicts that we can achieve that in 6 months and that is when I would like to have the tummy tuck surgery. My lower body is all muscle but I have a very fatty upper body. I have significant visceral fat and of course subcutaneous fat below the skin which will be removed during the tummy tuck. My weight has fluctuated a lot in the past which has resulted in a very lax bulging abdominal wall and stretch marks on the skin. I was recommended to have a full tummy tuck with flank liposuction and central abdominal liposuction as well. But I don’t want central abdominal liposuction, I don’t want to risk any healing and circulation complictitons. It can be done later after the tummy tuck. I have attached pictures of my stomach for your review.

A: Thank you for sending your pictures. I would certainly agree that your tummy tuck should wait until you have maximized your weight loss. That is the only way to reduce your visceral fat component of your abdominal protrusion. This will also allow for the most extra skin to be taken during the tummy tuck as well. I would also agree that any abdominal liposuction or etching can be done as a second stage procedure. That is both safer and more effective when done that way.

Dr. Barry Eppley
Indianapolis, Indiana

Tummy Tuck

Q: Dr. Eppley, I am in the process of reaching my ideal weight and have been researching tummy tuck surgery I have had two children via c section and I have been over weight/obese for many years. I am currently 5’5″ and weigh 227. I have lost 60 pounds so far but I’m wanting to lose another 40-50. I was wondering when I should start the tummy tuck process with a consult? I know I have a ways to go but I wasn’t sure what the requirements are before having a consult. Do I need to reach a certain BMI or be within so many pounds of my ideal weight? Like I said I’m just researching now and trying to plan for the future. I have double rolls of skin/fat around my abdomen and a lot of sagging already. I’m sure part of that will shrink but I also know I need muscle repair too. Thank you so much for your time and any info you can provide!!

A: Congratulations on your weight loss. This is a great question and a very proactive one. As a general rule when there is weight loss needed before a tummy tuck, one should not have the surgery until one is within 10 to 15 lbs of their weight goal. However, when one is undergoing extreme amounts of weight loss (bariatric surgery or otherwise), one may find that there comes a point when the skin rolls and their ongoing persistence (your skin rolls will not shrink much if at all) will cause one to consider where surgery may need sooner rather than later. I would continue with the weight loss until you hit the proverbial wall and no further change in how you look has become apparent. Then it is time to have a tummy tuck, or what is more likely an extended tummy tuck or body lift, consultation.

Dr. Barry Eppley

Indianapolis, Indiana

Tummy Tuck

Q: Dr. Eppley, I had a gastric bypass surgery three years ago to lose weight. I have lost nearly 200 pounds. I am a 50 year-old female. My primary insurance is Medicare and my secondary is Champ VA. i did not have to pay a penny for my gastric bypass. I saw a story on my local news tonight about Cool Sculpting. A procedure that costs $1,500. by a doctor in California. One place locally here has given me a quote of $7,600 tor a tummy tuck, but there is no way I’ll ever be able to save that much money. I have no credit cards. I don’t even have a car or a phone. I cannot afford a monthly payment on a car much less the insurance. Nor can I afford a monthly payment on a phone. My car broke down last year with a cracked engine in January. I rent a car when I need to go out of town. Thank you.

A: When one has lost 200 lbs, the overall circumferential body problem is too much skin. Do not waste your time and money on anything other than a major tummy tuck operation. There is nothing less than a big operation to cut out the extra tissues that will work. You may have luck finding a plastic surgeon who takes Medicare to do your surgery (which is very scarce) or you may be able to have it done in a VA. But other than these unlikely options, being able to do a tummy tuck like you would undoubtably need at just $7,600 is a bargain. Whomever offered to do your surgery at that very low rate for a tummy tuck like you would need was doing you a major favor.

Dr. Barry Eppley

Indianapolis, Indiana

Tummy Tuck

Q: Dr. Eppley, I have had two abdominal surgeries. The first was a hepatic bypass and the last one was a partial hepatectomy. My last surgery was complicated with infection at the organ level as well as an incisional hernia. The surgeon plans to surgically repair the hernia in May or June of 2016. I am interested in having a tummy tuck at the same time. I am not sure if I am a candidate or not. Would need to know if the two surgeries can be done at the same time.

A: The question you ask about a concurrent tummy tuck done at the same time as an abdominal wall reconstruction (hernia repair) is determined based on the consideration of multiple issues. First I would have to see pictures of your abdomen to determine the tissue excess and the location of your current abdominal scars. The location of certain abdominal scars may preclude or at least potentially complicate healing of the tummy tuck incision. Secondly, you would have to be in good medical health (which I would assume you would be for a hernia repair), on no immunosuppression drugs and be a non-smoker. I would need to know more about your medical history. Lastly there is the economics of doing a cosmetic surgery procedure in a hospital. While many patients think that most of the cost of the surgery would be covered by insurance because one is already asleep and having surgery, that is not the case. Hospitals are well aware of what is being done and will hold the patient accountable for the time and costs of the tummy tuck surgery, including OR costs and anesthesia, up front.

Dr. Barry Eppley

Indianapolis, Indiana

Tummy Tuck

Q: Dr. Eppley, I am interested in tummy tuck surgery. Can you please tell me the cost of tummy tuck surgery in your practice? Also what is the recovery time from tummy tuck surgery?
A: Thank you for your inquiry. There are eight different types of tummy tucks with differing associated costs. I would need to see some pictures of your abdomen to give you a very specific cost figure. Most women are type 4 so I will have my assistant pass along the cost of that version to you. That may or may not be the type of tummy tuck that you need. There are three different levels of recovery and it depends on what you are defining as your recovery point. (up and about, back to work, working out, final recovery) Since full recovery from a tummy tuck takes a complete eight weeks, I am assuming you are referring to some level of incomplete recovery where you can get at least back to that type of activity. Working backwards then it would six weeks for working out/running, four weeks for any job that has a significant physical components to it, two weeks for a sit down job and seven to ten days to be more up and about.

Dr. Barry Eppley
Indianapolis, Indiana

Diastasis Recti Muscle Repair

Q: Dr. Eppley, I need diastasis recti muscle repair. I need to see if your office can do a pre determination through my insurance for this procedure. I have chronic low back pain and do not want to continue to take 500-1000 mg of Naproxen for life or Cortisone injections.. I have joined weight watchers and lost 15 lbs and I am not morbidly obese but my back makes my quality of life poor. I cannot jog, run. I cycle 30-60 miles or more a week indoor spinning. I cannot lose my belly since my csection no matter how hard I work out. Can you please help. My back is getting worse and I’m at my wits end. I know that insurance can pay for alot of the procedure but I know I will need abdominoplasty also, but please can you help!

A: Thank you for your inquiry but I am not sure where you are getting information that would indicate that insurance would pay for a diastasis recti muscle repair…as they will not. Insurance only covers two adbominal type procedures for medical reasons…a hernia and in some cases an abdominal panniculectomy. A hernia is not the same as a diastasis of the rectus muscles. A hernia is an actual defect in the abdominal wall where bowel may or may not poke through. A diastasis is a separation of the midline of the vertically oriented rectus muscles but is not an actual defect of the abdominal wall. Most women have a rectus diastasis of various widths from pregnancies. Insurance will cover repair of an abdominal wall defect (hernia) but not for a muscle separation that is not associated with a hernia

In tummy tuck surgery it is common to have a diastasis recti muscle repair with the removal of extra skin and fat. While it is part of almosyt every cosmetic tummy tuck it is not a medically necessary procedure as defined by insurances.

Dr. Barry Eppley

Indianapolis, Indiana

Pubic Liposuction

Q: Dr. Eppley, I am interested in pubic liposuction. I had a tummy tuck over ten years ago and my pubic area is rather puffy and i would like to get liposuction to remove the fat that completely sticks out on each side of the seam in my pants or it is disgusting in my bathing suit. I have an appointment with another plastic surgeon but I like all that you have said about this after tummy tuck problem so you seem to be experienced in what I am looking for.

A: It is very common after a tummy tuck that residual fullness of the pubic region is seen. This is because the fat content of the pubic region has not changed (tissue thickness) while what lies above it has. Since the narrowest portion of a tummy tuck is usually the scar line this makes the unaltered pubic region more evident after surgery. While many patients think that the pubic fullness is persistent swelling from the tummy tuck, this potential cause can be eliminated once one is six months after their tummy tuck. Pubic liposuction is the solution to the puffy mons and is tremendously effective at reducing its profile and making it flatter.

Dr. Barry Eppley

Indianapolis, Indiana

Tummy Tuck

Q: Dr. Eppley, I am interested in a full tummy tuck. I believe I would accept the trade off of the scar for the results of the tummy tuck. My loose skin bothers me so much I do not take my shirt off in front of anyone and I will not wear a bathing suit. I find myself covering my stomach with my arm even when I am alone. It would ultimately depend on how high the incision would be and how inconspicuous it would be over time. I have researched hundreds of before and after photos on real self and women with similar “before” photos like my stomach and was very impressed with the results. With my C-section incision, my appendectomy incisions and all the stretch marks from pregnancy I think the incision would be a fair trade. Again, I would want to know where the incision would be and I know that could only be accomplished through an in-person consultation.

I am slightly concerned about the nipple lift for my breast augmentation. I am not sure what that entails, but it makes me more nervous than the tummy tuck incision. I am most concerned of lost sensation and additional scarring as a result.

A: You have made a key point in understanding the aesthetic trade-offs of many cosmetic procedures, particularly that of a tummy tuck. Each option (keeping your loose abdominal skin vs a tummy tuck) is not perfect and you choose which ‘problem’ you can live with the best. The tummy tuck scar will not end up as low as your c-section scar and will probably end up 1 to 2 inches higher. Also it would be likely that our full tummy tuck scar will end up with a small midline vertical component running just above the horizontal part of the incision. This is sometimes necessary when doing a full tummy tuck to keep the central aspect of the scar low rather than being pulled up in the middle. While many tummy tuck scars do heal well, I don’t think I would ever call them inconspicuous but that is a matter of personal perspective.

The small nipple lift scars are really irrelevant and are not a concern for visibility or nipple sensation. The choice you will have to make is that your nipples may not be centered on your breast mound without them given your existing breast sagging. It is important to understand that implants do not create a lifting effect on the breasts. They merely make breasts bigger and can magnify any existing breast asymmetry or breast sagging.

Dr. Barry Eppley

Indianapolis, Indiana

Tummy Tuck

Q: Dr. Eppley, I am interested in getting some initial information about a tummy tuck and breast lifts. I also sustained an injury to one buttock, leaving a large dent of scar tissue that I would like to have repaired if possible.

A: There are numerous types of tummy tuck surgery (eight to be exact) and breast lifts (four to be exact) so it is impossible for me to say which type of tummy tuck and breast lifts would be best for you. I am also unsure what your buttock deformity looks like although I could imagine. The good thing is that that tissue from the tummy tuck (dermal-fat graft) or fat injections from any liposuction can be used for reconstruction of the buttock indentation. I could provide you with more specifics about these procedures if I knew what you looked like. You could do that by sending in some pictures of your abdomen and breasts. Otherwise I would have to see you in the office to know exactly what you need.

A tummy tuck, breast lifts and buttock fat grafting could all be done in a single operation which would allow for just one recovery. The tummy tuck is usually what requires the most recovery. The recovery from other procedures falls well within that of the tummy tuck recovery period.

Dr. Barry Eppley
Indianapolis, Indiana