Introduction: What is a Panniculectomy?
A panniculectomy is a surgery to remove the excess skin and tissue from the lower abdominal area, which is referred to as the pannus. The surgery is often performed as an adjunct to a tummy tuck procedure and is a functional procedure to remove the excess overhanging skin from the lower abdomen to create a smoother abdominal contour. A panniculectomy differs from an abdominoplasty in that there is no dissection above the level of the belly button, no tightening of abdominal wall musculature and generally no changes to the belly button.
It is important to note that a panniculectomy is not a weight loss procedure, and it is not a substitute for diet and exercise.
Deep internal fat cannot be addressed by a panniculectomy and must be lost only by diet and exercise. A panniculectomy also does not correct stretch marks, although a benefit of a panniculectomy is that many of your stretch marks may be removed if within the planned area of skin excision.
Who is an Ideal Candidate for a Panniculectomy?
You may be an ideal candidate if you:
- Have excess skin and tissue in the lower abdomen without significant excess skin above the belly button
- Massive weight loss patients
- Are relatively healthy and your weight has been stable over the past 6 months
- Don’t smoke and are physically active
- Have realistic expectations of surgery
Preoperative Assessment
Before your procedure, a detailed medical history is obtained, and a thorough physical examination is performed. During your consultation, your doctor will advise you to stop smoking, if you smoke, to avoid post-surgical complications and delayed healing. You should eat a healthy diet and avoid any restrictive dieting during this time. You should inform your doctor of all medications that you are taking and about significant medical conditions, allergies and previous surgeries if any.
Photographs will also be taken during pre-operative consultation to submit for insurance, to be used in surgical planning, and for before and after comparison. Your goals will be discussed, and realistic expectations will be set. After discussing surgical options, we will make an individualized surgical plan together that best suits your goals.
This is the best time to ask all your questions so that you can feel comfortable and confident going into surgery.
Procedure: Panniculectomy
The panniculectomy procedure involves the following steps:
- General anesthesia is administered so you will be comfortable during the procedure.
- A horizontal incision is made extending from one hip bone to the other.
- A vertical midline incision may be made from the belly button area extending down to the pubic bone if there is excess tissue and skin in this area.
- In some cases, the belly button may also be repositioned or removed.
- Surgical drains will be inserted to allow for drainage of excess fluid.
- The remaining tissue and edges of skin are pulled together and sutured in place.
- For the most part your incisions will be closed with dissolvable sutures that will be under the skin and you will have either surgical glue or surgical tape over your incisions which take about 1-2 weeks to fall off.
- You will have drains in place after surgery that will be removed in 1-2 weeks.
Recovery after Panniculectomy Procedure
After panniculectomy there will be some temporary pain, discomfort, and swelling. Medications will be prescribed to relieve pain. You will be advised to rest with your hips and knees bent to minimize tension on the repair. You will wear a contoured elastic garment for extra support around the abdomen. Most patients can undergo panniculectomy as an outpatient procedure. Some patients may stay overnight for observation which will be discussed in your pre-operative appointment. Upon discharge, patients will be instructed about proper wound care and how to manage their drains at home. Stitches are usually dissolvable and internal. Specific post-operative care regimen to minimize scarring will be discussed with each patient. Strenuous physical activity and heavy lifting over five pounds is discouraged for six weeks post-operatively – details of this limitation will be discussed with you specific to the surgery that you will be having. You will likely be able to resume work in 2 to 3 weeks depending on what kind of job you have and how you are feeling. Full recovery may take a couple of months and you need to have follow-up appointments to ensure a positive surgical outcome.
Risks and Complications of Panniculectomy
As with any surgery, there is a minimal risk of complications that include:
- Anesthesia risks
- Bleeding
- Blood clots in the lungs or legs
- Delayed healing
- Fluid collections (seroma)
- Fat necrosis
- Numbness or changes in skin sensation
- Asymmetries or suboptimal aesthetic results
- Recurrence of loose skin
- Scarring
- Infection
Summary
Panniculectomy is a more functional type of procedure that not only improves abdominal contour but improves personal hygiene and reduces risk fo skin rashes or ulcers due to an enlarged pannus. Patient’s quality of life is improved by removing the excess skin that has been impeding their activities of daily living.
