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Following massive weight loss, individuals can be left with a flap of skin hanging over their thighs and genitals. This excess skin is known as the abdominal apron or pannus.

In cases where this skin hinders daily life, or is simply visually unappealing, a panniculectomy can be performed, either alone or in combination with other body contouring procedures.

The pannus: Just what is it anyway?

A pannus is an apron of skin that hangs over a patient’s thighs and genitals, usually as the result of rapid massive weight loss, while a panniculectomy is the name of the surgical procedure physicians employ to remove it.

The pannus is unpleasant business, causing back pain and skin rashes in the pubic area. Even basic personal hygiene is compromised by the useless, leftover flap of skin. As Boston based plastic surgeon Dr. Samuel Lin points out, “a panniculectomy helps patients with the rashes and irritation that occur under the pannus of the abdomen”.

Panniculectomy procedures are often necessary not only to improve personal hygiene and mobility, but they also leave patients with a slimmer appearance, helping them look better both in and out of their clothes, and by extension doing a world of good for their self-confidence.

Ideal panniculectomy candidates

Ideal candidates for this procedure:

  • Are bothered by excess skin below the lower abdomen following dramatic weight loss or pregnancy
  • Are physically healthy and at a stable weight
  • Are non-smokers
  • Have realistic expectations of the procedure’s outcome

Panniculectomy patients are most commonly individuals who were once critically overweight but have since shed many pounds, often following a gastric bypass or other bariatric surgery procedures. Losing a significant amount of weight this way typically leaves a large amount of excess skin behind.

As postpartum women also comprise a significant portion of the candidate pool for the operation, it’s not uncommon for it to be performed in conjunction with mommy makeover procedures. While panniculectomy surgery is often confused with abdominoplasty, these two plastic surgery procedures are different. The former only removes excess skin and tissue from the lower abdomen (under the navel), while the latter also involves tightening the abdominal muscles.

As Salt Lake City based plastic surgeon Dr. Renato Saltz points out, “a panniculectomy addresses the excess skin and fat layers only, without repairing any muscle separation. If the patient has a rectus diastasis, where the two rectus abdominis muscles are separated at midline, commonly seen after pregnancy or any other large abdominal mass or hernia, a plication (suturing the muscles together) will be necessary. This procedure is called an abdominoplasty.”

In other words, a panniculectomy essentially amputates the pannus, whereas combining it with an abdominoplasty will ideally leave you with a more sculpted, aesthetically pleasing abdominal area.

Any competent board-certified plastic surgeon will of course consider a range of factors when deciding if a patient is a good candidate for a panniculectomy.

For starters, the patient should ideally be a non-smoker with a firm commitment to living a healthy lifestyle. Plus, they need to have maintained a steady weight for six months to a year after their initial big weight loss and should carry realistic expectations of what a panniculectomy will and will not do for them.

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The procedure

The surgery itself typically takes between two and five hours from start to finish, depending on the patient, the surgeon, and if other procedures are performed simultaneously.

Lin explains: “Panniculectomy by itself is a procedure that takes me two to three hours to complete, but when combined with other procedures can take between three and six hours in total. The surgery involves making an incision that follows the contour of the upper and/or inner thigh, to the waistline. This can extend around the waist and lower back when indicated from the front of the abdomen. To adjust the buttock and thighs, additional incisions are made at the crease of the buttocks. Throughout, any excess fat is removed and finally, the skin is contoured and sutured into the new configuration.”

It’s important to note that there are times when a panniculectomy will result in the loss of the navel, with some doctors even charging an additional fee just to save your belly button. Consequently, your doctor should express the likelihood of this possibility over the course of your initial consultation. If not, ask them what their policy is so far as preserving navel’s is concerned, especially if keeping it results in additional fees.

Recovering from panniculectomy surgery

Depending on the individual’s circumstances, a panniculectomy patient can expect to remain in the hospital anywhere from one night to a few days following surgery. Over this period drains are usually inserted into the patient’s incisions in order to extract any excess fluids, and later removed once the levels of fluid extracted are consistently low over a given period of time determined by the physician.

Initially, sponge baths will be the only bathing permitted and compression garments will most likely be prescribed so that the belly area is consistently supported while healing. Patients can expect the relatively moderate levels of pain, bruising, and swelling to decrease as time goes on, while their physicians will help to alleviate any serious pain they could experience by prescribing the appropriate medication.

Any demanding exercise, heavy lifting, or sporting activities will be off limits for at least six weeks following the operation. Prior to the six week mark, patients should consult their doctor before adding any light physical activities to their routine.

Full recovery can take several months for some people, and as with any medical procedure it’s important patients pay strict attention to all of the post-operative instructions provided to them. At the same time, complications from panniculectomy’s are quite rare, especially when patients follow their doctors instructions as closely as they should.

As Paramus, NJ based plastic surgeon Dr. Frank Ferraro confirms, “recovery from a panniculectomy is very similar to recovering from an abdominoplasty, which is to say, like the procedure itself, not particularly risky.”

Poentential risks and complications

Nevertheless, as with any surgery, there are some potentially significant risks associated with the panniculectomy as well. While it’s true they’re quite rare, that’s still no excuse not to be fully aware of them.

The list of risks potential complications and side effects includes:

  • Infection
  • Excess fluid in the abdomen
  • Excessive scarring
  • Blood clots

Plus, there are times when revision surgery may be required when some unforeseen complication creates a problem, or when the patient has compromised their own recovery by participating in an unsanctioned activity.

Before electing to have a panniculectomy, however, patients should speak to their provider to see if there are other realistic alternative treatments to consider.

While the majority of people who need a pannus removed from their abdomens will require surgery, in some instances it may be possible to achieve acceptable results through a combination of liposuction and various other treatments.

That said, it’s totally unrealistic to expect liposuction alone to remove an amount of tissue as large as a pannus and somehow miraculously leave patients with tighter skin and a nicely contoured belly immediately afterward.

Nevertheless, patients should discuss all potential options with their doctors to see which holds the most promise for them personally and determine whether a panniculectomy, perhaps combined with another procedure, will indeed lead them to the best possible conclusion.

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The cost of panniculectomy surgery

The cost of a panniculectomy can and will vary depending on a wide array of factors, including the extent of the procedure, the volume of skin removed, the city where the patient is being treated along with the experience and reputation of the practitioner performing the operation.

The average patient can expect to pay between $7,000 and $12,000 for this procedure when performed in the United States.

In some cases health insurers will pick up the tab as there are basic, arguably essential, health benefits to be derived from this surgery. If it is determined that the patient’s condition inhibits “daily activities of living,” treatment required to eliminate or reduce such interference may be covered.

However, purely cosmetic procedures are never reimbursed by medical insurance.

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About The Author

Articles by

Gary D. Breslow, MD, FACS is a highly regarded board certified plastic surgeon in New Jersey, known by both patients and peers as a problem-solver with a warm, engaging personality, and an instinctive ability to identify and truly understand the goals of his patients and the patients, themselves.

Originally from Long Island, New York, Dr. Breslow graduated from Brown University with a Bachelor of Science degree and received his medical degree from New York University School of Medicine.

Following medical school, Dr. Breslow spent 6 years training at the Hospital of the University of Pennsylvania’s nationally renowned Integrated Plastic Surgery Residency Program. There he received extensive training in both cosmetic and reconstructive surgery from some of the nation’s top practitioners. After leaving Penn, he returned to NYU Medical Center to spend one year as the Microvascular Reconstructive Fellow at NYU’s prestigious Institute of Reconstructive Plastic Surgery.

Dr. Breslow is Board-Certified by the American Board of Plastic Surgery. He is a member of the American Society of Plastic Surgeons, a Fellow of the American College of Surgeons, and is licensed to practice plastic and reconstructive surgery in both New Jersey and New York.

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