RAG rating
Document type
Clinical policy
Hertfordshire and West Essex ICB
Output type
Clinical Policies & Evidence-based Interventions

Abdominoplasty & Apronectomy


Abdominoplasty (tummy tuck) is an operation to remove excess skin and fat from the abdomen. An apronectomy is a less extensive procedure which only removes excess skin and fat from the lower abdomen. They are regarded as a form of body contouring surgery and reduce functional difficulties that can occur, for example, after substantial weight loss. The procedure should not be commissioned for purely cosmetic reasons, but it should be funded if a specific set of criteria are met looking at a patient’s BMI, other health conditions and functional problems.
Evidence shows that overall, the surgery increases patient quality of life, with improvement seen in physical and psychological wellbeing. There are differences in how this procedure is commissioned and therefore who can access the procedure. 
The EBI programme proposes clear, evidence-based criteria for use across England. The expected outcome from the use of these criteria is equitable access to abdominoplasty/apronectomy, across England.

Clinical overview 

Abdominoplasty (tummy tuck) or apronectomy are operative procedures that aim to resect excess skin and subcutaneous fat from the abdominal wall, with or without plication of the rectus muscles and repositioning of the umbilicus. Currently, this procedure is used in patients after significant weight loss (either spontaneous or after bariatric surgery), significant scarring following trauma or previous abdominal surgery, or where it is required as part of abdominal hernia correction or other common abdominal wall surgery.
Abdominoplasty is regarded as a form of body contouring surgery and is a means to limit significant functional difficulties that may arise after massive weight loss or abdominal wall pathology.


Abdominoplasty or apronectomy should not be commissioned for cosmetic reasons and should be offered only in exceptional cases for those patients evidencing a strong clinical need. 
The following criteria should be fulfilled: 
  • Age 18 or over AND
  • Starting BMI above 40, OR more than 35 with significant co-morbidities AND
  • Current BMI less than 30 and weight stability for greater than 12 months AND
  • Significant functional problems -Abdominal apron (pannus) hanging at or below level of the pubic symphysis AND 
  • Experience of severe difficulty with activities of daily living (including ambulatory restriction or urological issues) OR
  • Recurrent intertrigo beneath the skin fold, panniculitis or skin ulceration OR
  • Scarring from previous trauma or abdominal wall surgery that leads to a very poor appearance and results in disabling psychological distress or infection. OR
  • When it is required as a part of abdominal hernia correction or other abdominal wall surgery.

Expected outcome

The implementation of this proposed guidance would result in a reduction in unwarranted variation of access across England to abdominoplasty/apronectomy by standardising the criteria for referral. Overall, there would be an increase in the number of referrals for the consideration of abdominoplasty/apronectomy.

Rationale for recommendation

Regional variation exists in the commissioning of abdominoplasty. Some commissioners have commissioning guidance setting out specific criteria for surgery, such as functional difficulties, associated chronic skin conditions or infections, or where it prevents effective other surgeries (e.g., stoma formation or hernia repair), but this varies between commissioners. National guidance from the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) provides an approach to rationalise and outline patients who may be considered as appropriate surgical candidates. A standardised approach to commissioning is required to ensure the appropriate surgical candidates have access to surgery, therefore improving their quality of life.
Systematic reviews of abdominoplasty have revealed high levels of patient satisfaction, increased quality of life and improvement of functional status. These reviews have indicated a significant increase in both physical and psychological wellbeing. 

Patients who are not eligible for treatment under this policy may be considered on an individual basis where their GP or consultant believes exceptional circumstances exist that warrant deviation from the rule of this policy. Individual cases will be reviewed as per the ICB policy.

Information Sources
  1. British Association of Plastic Reconstructive and Aesthetic Surgeons and Royal College of Surgeons. UK Commissioning guide: Massive Weight Loss Body Contouring. 2017 Available at:  http://www.bapras.org.uk/docs/default-source/commissioningand-policy/rewrite-for-2017--final-version.pdf?sfvrsn=4 
  2. NHS advice Available at: https://www.nhs.uk/conditions/cosmetic-procedures/tummy-tuck/ 
  3. Gilmartin J, Bath-Hextall F, Maclean J, Stanton W, Soldin M. Quality of life among adults following bariatric and body contouring surgery: a systematic review. JBI Database System Rev Implement Rep. 2016 Nov; 14(11):240-270 
  4. Rosenfield LK, Davis CR. Evidence-Based Abdominoplasty Review with Body Contouring Algorithm. Aesthet Surg J. 2019 May 16; 39(6):643-661
  5. Klassen AF, Cano SJ, Alderman A, Soldin M, Thoma A, Robson S, Kaur M, Papas A, Van Laeken N, Taylor VH, Pusic AL. The BODY-Q: A Patient-Reported Outcome Instrument for Weight Loss and Body Contouring Treatments. Plast Reconstr Surg Glob Open. 2016 Apr 13; 4(4):e679
  6. Poulsen L, Klassen A, Rose M, Roessler KK, Juhl CB, Støving RK, Sørensen JA. Patient-Reported Outcomes in Weight Loss and Body Contouring Surgery: A Cross-Sectional Analysis Using the BODY-Q. Plast Reconstr Surg. 2017 Sep; 140(3):491-500 
  7. Hunecke P, Toll M, Mann O, Izbicki JR, Blessmann M, Grupp K. Clinical outcome of patients undergoing abdominoplasty after massive weight loss. Surg Obes Relat Dis. 2019 Aug; 15(8):1362-1366 8. NHS Hounslow CCG. Abdominoplasty/Apronectomy policy. 2016 Available at: https://www.hounslowccg.nhs.uk/media/79500/AbdominoplastyApronectomy-v41.pdf 
  8. NHS Dorset CCG. Apronectomy/Abdominoplasty Criteria Based Access Protocol. 2018 Available at: https://www.dorsetccg.nhs.uk/wp-content/uploads/2018 /04/Apronectomy.pdf 
  9. NHS Somerset CCG. Abdominoplasty/Apronectomy Evidence Based Interventions (EBI) Policy. 2020 Available at: https://www.somersetccg.nhs.uk/wp-content/uploads/ 2020/10/20200319-Abdominoplasty-Apronectomy-EBI-Policy-2021.v2-1.pdf 
  10. NHS Sheffield CCG. Commissioning Guidelines Specialist Plastic Surgery Procedures: 2016 Available at: https://www.sheffieldccg.nhs.uk/Downloads/About%20US/ Documents%20Policies%20and%20Publications/IFR%20policies/SHEFFIELD%20 CCG%20Plastic%20Surgery%20Procedures%20Jan%202016.pdf