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.
A: 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.
Q: Dr. Eppley, I am wondering if I am a candidate for an abdominal panniculectomy procedure. What I mean by being a good candidate is whether insurance will pay for the procedure. removal. I am not sure if I am a grade 2 or 3 pannus.
A: Only your insurance company can truly answer the question of whether an abdominal panniculectomy would be covered but the basic criteria are:
1) an abdominal pannus that covers the groin crease and hangs onto the thighs,
2) an abdominal pannus that is associated with recurrent groin crease skin infections that has a documented three month history of topical skin treatments (non-surgical therapy) that has failed,
3) a BMI of less than 30 or a body weight that in within 20% of their ideal body weight based on standard height and weight measurements.
If one does not fulfill all three criteria, my experience has been that approval for abdominal panniculectomy surgery will be denied. And in some cases, even if all three criteria are met, a denial will still be given. It is also important to check whether your insurance company has a policy exclusion for panniculectomy surgery, as many companies now do, so this may not be a surgical procedure that is even eligible for coverage.
Q: Dr. Eppley, I am interested in a tummy tuck which is needed after my bariatric surgery. After my bariatric surgery I’ve had this horrible itching and burning under my skin flap over my c-section scars. Do you thing my insurance would help pay for me to get a tummy tuck? I am too embarrassed by my body to swim or dress in front of anybody. It really is horrific on my life.
A: For the sake of clarification, you are specifically asking about an abdominal panniculectomy not a tummy tuck. An abdominal panniculectomy is a potentially medically indicated procedure to treat a flap of overhanging skin that causes dermatologic problems underneath it due to chronic moisture. A tummy tuck is a purely cosmetic procedure that removes loose abdominal skin and fat that may or may not have some waistline overhang.
Only your health insurance company can truly answer the question of whether an abdominal panniculectomy would be a covered procedure. That needs to be obtained through what is known as a predetermination process. This involves a consultation from a plastic surgeon from which a predetermination letter with picture and medical documentation would be submitted. From this information, your health insurance company will then determine whether they authorize coverage.
While only the insurance company can make that decision, there are very specific criteria that they look for in determining that eligibility. Without all of them, it will most assuredly be denied. They include photographic documentation of an abdominal pannus that hangs over the groin crease onto the upper thighs, photographic documentation of redness/skin irritation under the abdominal pannus, and medical records that demonstrate there has been a history of skin infections that have been treated by topical methods that have recurred despite these treatments.
Q: Dr. Eppley, I am interested in getting a body lift. I have had bariatric surgery two years ago and I need to get rid of excess skin. This excess skin around my waistline is causing severe chafing. My insurance won’t cover ‘cosmetic’ surgery. My question is this: can we get insurance to cover it if it is a medical necessity?
A: Insurance in some cases will cover an abdominal panniculectomy but it depends if the abdominal pannus meets several criteria established by the insurance industry. for such coverage. The abdominal pannus must of a certain size as seen in multiple view pictures (hangs down onto the upper thighs), have a medically documented history by a physician of skin rashes/infections that failed to be resolved by topical therapies and one must be of appropriate weight based on their height. (within 20% of their ideal body weight) Fulfilling these criteria is what constitutes ‘medically necessary’ and such information must be submitted to the insurance company for them to pass judgment on whether it is covered or not.
Even if determined medically necessary, insurance will only cover the front half of the trunk (abdominal panniculectomy) and to the back half or the full body lift.
Q: Dr. Eppley, I honestly need an abdominal panniculectomy and need a price. I do have Medicare and Medicaid. I live in Indiana. How much do they cover and how much would it cost out of pocket. I get rashes and yeast infections because of it. It hangs down to lower pelvic area.
A: There are two options to consider regarding an abdominal panniculectomy. It can be done through my private practice on a self pay basis as an outpatient procedure. This is the most efficient method to have the procedure performed as surgery could be done in matter of weeks at an outpatient facility. All follow up care iss done at one of my private offices. The other route is to use Medicare for the procedure. Medicare is primary over Medicaid so it needs to be approved through Medicare. This would need to be done through my Indiana University practice, meaning you would have to go to downtown Indianapolis to be evaluated, photographs taken and medical records obtained to document the time and number of treatments done to treat the skin infections. To qualify for Medicare coverage the abdominal pannus must be of a certain size (hanging down onto the thighs), rashes must be present underneath it and there must have been a course of at least 3 months of care provided for the skin infections/rash from your doctor. Surgery would have to be done at an Indiana University Health Hospital and all followup care done in downtown Indianapolis. It would take a few months to determine of you qualify.
I would need to see some pictures of your abdominal pannus to determine if Medicare is even an option and I also need some information about your general medical history.
Q: Dr. Eppley, I have been trying to get an abdominal panniculectomy since I lost so much weight. My insurance company denied me but I plan to appeal. I have infections and skin ulcers. It makes it hard to do my job. I heard about the Patriot Plastic Surgery Program and wondered if you can help. PLEASE!!! I wanted to get this done before my husband got home from his latest deployment and I was wanting to get this done before he got home and I’ve run into roadblock after roadblock. Can you help? I have attached some pictures of my abdominal problem.
A: While there is little doubt that you would benefit from an abdominal panniculectomy, I am not surprised that you have been denied by your insurance company. By insurance requirements you do not meet the very basic criteria of the size of the pannus, it must reach down and overlap onto the thighs. Plus there must be a 6 month history of medically documented skin infections that have failed to respond to topical therapies and there must also be current photographic evidence of active skin infections. Failure to meet all of these criteria will result in denial of coverage for an abdominal panniculectomy. This is a very common occurrence and can be difficult to appeal without providing documentation of their established criteria.
The Patriot Plastic Surgery program is where some reduction in fees is offered for a variety of cosmetic surgery procedures, including tummy tuck and abdominal panniculectomy.
Q: Dr. Eppley, I have attached some pictures of my stomach pannus. Please let me know if I would be a good candidate for an abdominal panniculectomy. It is the most troubled part of my body. I have backaches and some times irritation underneath due to my jeans. I wear a size16 in pants but that is underneath my pannus. If I got pants to go over my pannus they would not fit my legs and hips properly. I hate this stomach!! 🙁
A: Thank you for sending your pictures. I do believe you are a good candidate now for an abdominal panniculectomy. The size of overhang of your pannus is significant and much functional improvement would come from its removal. You are not going to have a flat stomach from the procedure, however, and of this you should be aware. It will still be round due to the amount of intra-abdominal fat but there will be no overhang. In preparation for an abdominal panniculectomy, hopefully in the near future, I would still continue to make efforts to lose weight no matter how slight it may be. That will only enable as much stomach tissue to be removed as possible.
Q: Dr. Eppley, I am a 44 year old female. I weigh somewhere between 350 and 370lbs. I have spent many years with multiple medical problems. I currently have Crohn’s Disease, Diabetes (Insulin Pump), Fibromyalgia, Asthma, Underactive Thyroid, Pernicious anemia, CVID and Sleep apnea. Through the years, a strong use of steroids resulted in my right femur breaking. On my first surgery for the femur (Sep 2003), I developed MRSA. I spent the next 4 years constantly having surgeries and receiving vancomycin. In April 2007, the MRSA went dormant. This required removing all hardware from my leg. I currently have a lame right leg. I am wheel chair bound. It was after I permanently moved to a wheelchair that I began to gain weight. I am currently prednisone dependent and I must constantly watch for adrenal crisis. The steroids have greatly added to my weight. Since 2007, my weight has managed to stay around 350 – 360lbs. My skin in so thin and damaged from the steroid use that I have developed an extremely large pannicula. It is very large. On the right side of my body it hangs below the knee. On the left it hangs below the genital area. I develop ulcers in my stomach area. The ulcers often become large, oozy, painful and infected. I have had to take vancomycin to cure the infections. I have a location (at the end on the longest piece of pannicula) that receives inadequate blood flow and it has become hard like a rock. Additionally, I develop fungal infections. I had a C-section in 1999. The fungal infection seems to form on the scar and the infection spreads out. I develop open places along the C-section scar. These places itch and bleed. I am currently treating the fungal infection with a mixture of ketoconazole cream and Diaper rash cream. I also sprinkle a nyoxin powder on the fungal infection. The fungal infection is very difficult to treat. My Infection Disease Doctor and my Rheumatologist has suggested a Panniculectomy. Each doctor feels that it is important that I receive a Panniculectomy. The doctors said they feel a Panniuclectomy should be performed first and I should look at the gastric sleeve after I have healed. I have been unable to find a Doctor willing to perform this surgery. I know it is a high risk surgery. I am inquiring to find out if anyone in your facility has any experience with this surgery.
A: Thank you for your inquiry. You are literally between a rock and a hard place. Your needed abdominal panniculectomy procedure is more than just high risk…it is virtually certain to have a 100% complication rate when it comes to wound healing. And that is not to mention your general medical condition which will require considerable after surgery management and is certain to have its own set of complications that could even include severe infection and death. Between the wound and your health complications I could easily see you sending a long time in the hospital. Whomever decides to take on your surgery has to do it with a team approach and be expectant of what is going to ensue. Your best bet is to have this done at a university-based hospital where there is a plastic surgery training program due to the need for a lot of doctors caring for you both during surgery and afterwards.
Q: Dr. Eppley, I believe I need a pubic lift. I have lost 100 lbs and am still over weight by a lot. But I had an abscess removed from one side of the upper pubic area and I’m also uneven on both sides. If you type in pubic lift blog on yahoo and under images there is pictures I believe of one you did that is quite large like mine little different I presume. My question is cost and what would be the steps and healing?
one has lost 100lbs, I would have no doubt that a pubic lift is needed. But I am suspicious that you may need much more than that. Usually such weight loss causes a lot of abdominal tissue overhang which is most commonly called a pannus or apron. This is a hip to hip removal of the abdominal overhang that would include a pubic lift. It is possible that an isolated pubic lift may suffice, or be partially helpful, but I would have to see pictures of your abdominal area to make a visual evaluation. There is a big difference in the cost and recovery of a pubic lift vs. abdominal panniculectomy so knowing what you look like is essential to answer your questions with any accuracy.
Q: Dr. Eppley, I have an “apron” that hangs below my pelvic bone due to 3 c-sections. I have had this for 20 years. It is my dream to wear a wedding dress and not see the hang over through the dress. Would I have time to heal before wedding date of late October 2013?
A: Prepare to have your dream come true. One of the most rewarding of all tummy tucks is the removal of the abdominal apron, also known as a pannus. Its dramatic removal creates not only an instantaneous waistline change but a near lifestyle improvement without a floppy bag of tissue getting in the way of clothes, exercise, personal hygiene and intimate relations. Given that your wedding is over six months away, you will be in good shape for your wedding as long as you have the tummy tuck at least 3 months before the big day. The other good news is that after the tummy tuck there is no chance that this abdominal apron will ever come back unless one has more children (I am assuming after 3 that you are having no more) or unless you gain a tremendous amount of weight (greater than 50 lbs) and lose it again.
Dr. Barry Eppley
Dr. Eppley has earned a reputation as one of the world’s most innovative plastic surgeons, drawing patients from all corners of the globe seeking new and unique surgical solutions to their concerns.