Panniculectomy

Definition

Panniculectomy is a surgery done to remove stretched out, excess fat and overhanging skin from your abdomen. This can occur after a person undergoes massive weight loss. The skin may hang down and cover your thighs and genitals. Surgery to remove this skin helps improve your health and appearance.

Panniculectomy is different from abdominoplasty. In abdominoplasty, your surgeon will remove extra fat and also tighten your abdominal (belly) muscles. Sometimes, both types of surgery are performed at the same time.

Alternative Names

Lower body lifts - abdomen; Tummy tuck - panniculectomy; Body-contouring surgery

Description

The surgery will take place in a hospital or a surgery center. This surgery may take several hours.

• You will receive general anesthesia. This will keep you asleep and pain-free during the procedure.
• The surgeon may make a cut from under your breast bone to just above your pelvic bone.
• A horizontal cut is made in your lower belly, just above the pubic area.
• The surgeon will remove the overhanging extra skin and fat, called an apron or pannus.
• The surgeon will close your cut with sutures (stitches).
• Small tubes, called drains, may be inserted to allow fluid to drain out of the wound as the area heals. These will be removed later.
• A dressing will be placed over your abdomen. You may need to wear a binder.

Why the Procedure Is Performed

When you lose a lot of weight, such as 100 pounds (45 kg) or more after bariatric surgery, your skin may not be elastic enough to shrink back to its natural shape. This can cause the skin to sag and hang. It may cover your thighs and genitals. This extra skin can make it hard to keep yourself clean and to walk and perform daily activities. It also can cause rashes or sores. Clothing may not fit properly.

Panniculectomy is done to remove this extra skin (pannus). This can help you feel better about yourself and feel more confident in your appearance. Removing extra skin also may reduce your risk for rashes and infection.

Risks

Risks of anesthesia and surgery in general are:

• Reactions to medicines
• Breathing problems
• Bleeding, blood clots, or infection

Risks of this surgery are:

• Scarring
• Infection
• Nerve damage
• Loose skin
• Skin loss
• Poor wound healing
• Fluid buildup under the skin
• Tissue death

Before the Procedure

Your surgeon will ask about your detailed medical history. The surgeon will examine the excess skin and old scars, if any. Tell your doctor about any prescription and over-the-counter medicines, herbs, or supplements you are taking.

Your doctor will ask you to quit smoking if you smoke. Smoking slows recovery and increases the risks of problems. Your doctor will suggest you quit smoking before having this surgery.

During the week before your surgery:

• Several days before surgery, you may be asked to stop taking medicines that make it hard for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and others.
• Ask your doctor about medicines you should still take on the day of your surgery.

On the day of surgery:

• Follow instructions about when to stop eating and drinking.
• Take the medicines your surgeon told you to take with a small sip of water.
• Arrive at the hospital on time.

Note that panniculectomy is not always covered by health insurance. It is mostly a cosmetic procedure done to change your appearance. If it is done for a medical reason, such as hernia, your bills may be covered by your insurance company. Be sure to check with your insurance company before the surgery to find out about your benefits.

After the Procedure

You will need to stay at hospital for about two days after the surgery. You may need to stay longer if your surgery is more complex.

After you recover from the anesthesia, you will be asked to get up to walk a few steps.

You will have pain and swelling for days after surgery. Your doctor will give you pain killers to help relieve the pain. You may also experience numbness, bruising, and tiredness during that time. It may help to rest with your legs and hips bent during recovery to reduce pressure on your abdomen.

After a day or so, your doctor may have you wear an elastic support, like a girdle, to provide extra support while you heal. You should avoid strenuous activity and anything that makes you strain for 4 to 6 weeks. You will probably be able to return to work in about 4 weeks.

It takes about 3 months for swelling to go down and wounds to heal. But it can take up to 2 years to see the final results of the surgery and for scars to fade.

Outlook (Prognosis)

The outcome of panniculectomy is often good. Most people are happy with their new appearance.

References

Aly AS, Al-Zahrani K, Cram A. Circumferential approaches to truncal contouring: belt lipectomy. In: Rubin JP, Neligan PC, eds. Plastic Surgery: Volume 2: Aesthetic Surgery. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 25.2.

Padlilla PL, Khoo KH, Ho T Cole EL, Sirvent RZ, Phillips LG. Plastic surgery. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 69.

Nahabedian MY. Panniculectomy and abdominal wall reconstruction. In: Rosen MJ, ed. Atlas of Abdominal Wall Reconstruction. 2nd ed. Philadelphia, PA: Elsevier; 2017:chap 13.

Neligan PC, Buck DW. Body contouring. In: Neligan PC, Buck DW, eds. Core Procedures in Plastic Surgery. 2nd ed. Philadelphia, PA: Elsevier; 2020:chap 7.