A panniculectomy is a surgical procedure that
gets rid of the excess fat and skin that may hang down over the genital area and
thighs. This excess skin and tissue is known as the "pannus" or
abdominal apron, and
normally happens as a result of massive weight loss. The extra fat and
skin in these areas tends to be more than a "just a cosmetic problem" - as it
can cause back complications, skin chaffing, rashes and skin ulcers.
Tummy Tucks or Abdominoplasties are a
different surgical procedure from a panniculectomy. With an abdominoplasty,
not only is skin and fat removed, but repair of the rectus abdominal wall
muscles is normally performed. Patients undergoing abdominoplasty usually do not
have the same symptoms and functional problems associated with this massive
pannus With a panniculectomy, only skin and fat is removed.
A
Belt Lipectomy is also different from an abdominal panniculectomy. The belt lift is
done with an incision that goes around the entire
belt-line of the waist - across the lower portion of
the abdominal wall and down the inner thighs and
around the back. This procedure is considered a "circumferential incision"
around the waist and back.
The
fat and skin apron or what is called the abdominal panniculus is graded
according to its size and extent the sagging tissues hang down. The higher
the grade, the more extensive the surgical procedure that will be needed which
can increase complications.
Grade 1 - Pannus
apron reaches hairline and mons pubis - but not the private areas
Grade 2 - Pannus
apron reaches private areas level with the upper thigh crease
Grade 3
- Pannus apron reaches upper-thigh
Grade 4 - Pannus
apron reaches mid-thigh
Grade 5
- Pannus apron reaches knees
The higher grades of the Pannus Grading
System have more problems after the procedure.
The higher the grades may also be associated
with:
According to the ASPS - American Society of
Plastic Surgeons, a patient should wait at least one full year after weight loss
surgery - for the panniculectomy procedure. There are significantly fewer
complications with patients who wait a year than those who decide to get a panniculectomy sooner. Significant weight loss patients tend to have
underlying physical conditions such as high blood pressure, diabetes, etc. Patients who wait a year between surgeries are much healthier going into surgery
for the panniculectomy.
A panniculectomy is normally performed in a
hospital or an outpatient surgery center. General anesthesia will be
administered to the patient, as this procedure is complex. The actual
amount of time that will be scheduled for this procedure will be dependent on
the amount of skin and fat that is present.
A panniculectomy removes skin only. If you
need to have any kind of muscle repair done, then an abdominoplasty or tummy
tuck will be done at the same time. There are some patients that need to
stay in the hospital for a couple of nights after having this procedure.
Panniculectomy
surgery affects a very crucial part of your body. Though risks and complications
they’re rare, they do exist and can include - infection, bleeding under the skin
flap, or blood clots. You may carry an increased risk of complications if you
have poor circulation, diabetes, or heart, lung or liver disease.
Complications from an infection may be associated with graft
placement with the repair of a hernia as well as skin infections
such as
cellulitus or
erythema.
Cellulitis - is a spreading bacterial infection of
the skin and tissues beneath the skin. Cellulitis usually
begins as a small area of tenderness, swelling, and redness.
Erythema nodosum -
is an inflammatory condition of the skin and underlying fat.
These
two skin infections must be immediately attended to, usually
requiring IV antibiotics in a hospital.
The
scarring with the panniculectomy procedure can be significant,
however; scars tend to be a trade off for most patients with the
massive amounts of skin and tissue that is removed with the
procedure. Each patient is unique with their collagen
production and hereditary, making scars hard to predict with how
they will heal.
Keloid and
hypertrophic scarring can
occur sometimes, however; there are many new and innovative
treatments to help reduce these types of scars.
It is
not uncommon for large panniculectomies to have revision surgery
- especially if the patient is asking for more contours to be
done to the upper abdominal area, thighs, and hips. Most
surgeons like for the patients to wait a minimum of six
months before any revision surgery is done to reduce not
only the
anesthesia risks but also to reduce the incidents
of necrosis
occurring from the skin flaps. Revision surgery includes
either
abdominoplasty and or liposuction
of lower body area - including the areas of the hips and flanks.
A panniculectomy is an extensive surgical
procedure where the recovery is major, with taking several months for the wounds
to heal completely. Surgical
drains will be inserted into the incisions to help reduce any
swelling or edema. The patient will need to record how much drainage is
occurring, so your surgeon can keep track of how you are healing. The
drains are removed when the output of the fluid is low.
Your surgeon will give you pre and post operative
instructions. It is very important that you do everything your surgeon has
stated.
If drains are used post operatively, you more
than likely will have to take sponge baths until they are removed. A
compression garment will be given to you for support and comfort.
The post operative pain will be managed either by
a pain pump
or oral narcotics. Take the medication as prescribed, so there is no break
through pain. You will also be prescribed antibiotics and also something
for nausea.
Exercise will be limited for several weeks. There is to be no pressure on the abdominal area after surgery, so no heavy
lifting, etc. Your surgeon will have a list of what you can and cannot do
before and after your panniculectomy procedure.
There
are some insurance companies that will pay for a panniculectomy
- if it is considered medically necessary. You will have
to check your own individual policy limits regarding this issue.
Submitting documented proof of medical necessity and having it
approved by your insurance company is imperative.
Every single policy will have their own requirements - however;
most insurance companies will cover a panniculectomy procedure
if it fits the following guidelines:
The pannus apron is a Grade 2 or more
You have lost 100 pounds or more and have been at a
stable weight for at least six months
If a weight loss procedure was performed, such as gastric
bypass, the surgery was at least 18 months ago
Documented history of rashes or non-healing skin ulcers for
at least three months
The pannus apron causes difficulty with walking, sitting or
standing and interferes with daily life activities
