A panniculectomy removes hanging fat and skin, typically after massive weight loss. It may be performed as a single procedure or combined with a tummy-tuck, depending on the patient's condition. Panniculectomy is different from abdominoplasty, in that abdominoplasty tightens the muscle as well as removes excess skin and fat, but a panniculectomy only removes excess skin and fat. A panniculectomy may also be performed with another abdominal surgery, such as a hysterectomy, or repair of the abdominal wall or hernia of the belly button.
The Best Candidate for Panniculectomy
Panniculectomy candidates typcially suffer from obesity, or have recently experienced significant weight loss, or suffer post-pregnancy issues with inordinate fat localized below the belly button.
Candidates may have fat extending as low as the knees, over the hips, and around the back. These conditions cause panniculectomy candidates to experience a host of health issues, including back problems, the breakdown of skin, rashes, ulcers, or skin disorders. These conditions may interfere with everyday life — walking, standing, or sitting may become very difficult.
The best candidates have stabilized their weight for at least one year. The candidate must be participating in a proper dietary and exercise plan. Candidates who have had the gastric bypass procedure should wait until one year after gastric bypass surgery or Lap-Band surgery, after the health problems associated with obesity have subsided.
The Panniculectomy Procedure
The panniculectomy is most often performed by a board-certified plastic surgeon. The location of the procedure is typically a hospital, although the procedure may be performed in an outpatient surgery center. Time in surgery may be several hours. The procedure is often performed under general anesthesia (while you are asleep) and requires a hospital stay, typically ranging from one day to one week.
An incision is made from the lower area of the sternum to the pubic bone. Another horizontal incision is made at the pubic area where the excess fat and skin can be delicately removed. The skin that remains is then pulled together and closed. Drains may be inserted that will require personal home care. Tape will be applied to the incision areas. Any essential repairs to the abdominal wall or hernia within the belly button can usually be made at the same time.
After Panniculectomy
Your surgeon will supply a complete postoperative instruction list to follow, to reduce the risk of complications. You will have to sponge bath. Your doctor may fit you with a medical garment to wear at all times (except during a sponge bath) until otherwise directed.
If drains were inserted, the drains will need to be emptied as instructed. Dressings will also need to be changed.
Pain, swelling and bruising can occur, which can be managed with medications and proper care. Keep in mind that normal activities cannot be resumed immediately. Restrictions include no exercise or lifting of 10 pounds or more. There cannot be any pressure placed on the abdominal area.
Complications and Risks
Complications are possible with any plastic surgery. The most common but infrequent panniculectomy complications include infection, bleeding, and excessive scarring. If these occur, notify your surgeon immediately.
Consult a Qualified Plastic Surgeon
A qualified plastic surgeon will help ensure that a panniculectomy is appropriate for your condition. The most qualified surgeons can also increase your odds of success and reduce the risk of complications.
It's important to choose a board-certified plastic surgeon from the American Board of Plastic Surgery who has extensive, specific panniculectomy experience, as well as expertise in all areas of abdominal plastic surgery. Board certification may not always guarantee the best results; however, board certification does require specific and rigorous surgical education and training, which can help you achieve a safe and successful outcome.
Here are some tips for consulting a plastic surgeon:
- Review the doctor's credentials, education, training, type of certification held, and number of times that the treatment has been performed in the practice.
- View before-and-after photos of patients with similar conditions who received a panniculectomy and alternative surgical options.
- Inquire about the method of the procedure and possible complications from surgery.
- Ask for a pre- and postoperative instruction checklist.
Costs
Panniculectomy costs include three fees: local or general anesthesia fees, facility fees, and surgeon's fees. Since the panniculectomy procedure is usually performed during an abdominoplasty, you only pay one anesthesia fee and one facility fee. Since your treatment will be customized to fit your needs, only an estimated range of costs can be given. Average total fees range from $8,500 to $10,000.
Insurance coverage for the cost of the panniculectomy varies. If the procedure is strictly for cosmetic reasons, insurance will not cover the procedure. However, the insurance carrier may cover all or a portion of the costs if medical conditions are correlated with excessive weight. For example, hernia is often present in panniculectomy patients. In this case, the insurance will often pay for the hernia repair, but not necessarily the panniculectomy. The doctor will help identify whether the panniculectomy is covered under your insurance plan.
