Our body changes with aging, pregnancy, or weight gain or loss.  The abdomen often becomes the focus of dissatisfaction due to these changes despite our attempt to maintain a healthy diet and stay active.  Dissatisfaction does not only stem from the appearance of the excess, hanging skin and fat of the abdomen (also known as the pannus), but also from medical reasons.  Patients who seek panniculectomy want resolution of the recurrent infection of the skin of the pannus or panniculitis.  They want to maintain proper hygiene, to ambulate better, and to fit better in clothing.  Panniculectomy is not a cosmetic surgery, it’s done for medical reasons to improve quality of life.  (See before and after photos of panniculectomy surgery)

What is Panniculectomy surgery?

The surgery is done under general anesthesia.  The incision is typically from one hip to the other low in the pubic area and around the belly button.  The excess skin and fat below the belly button are removed.  The belly button will be transposed through the skin at about the same position on your abdominal wall.  There will be two drains placed during the surgery to help remove the fluid after surgery.  Panniculectomy is not a weight loss surgery.

Who are candidates for panniculectomy?

Ideal candidates are non-smoker, healthy individuals who have maintained an active lifestyle but are unable to get rid of the excess skin mainly and some fat of the lower abdomen.  Your weight must be stable for at least 4-6 months prior to surgery.  You need to have documented medical reasons such as recurrent infection of the pannus, difficulty walking or maintaining proper hygiene.   If you do smoke/vape or use any nicotine product, you need to stop using for at least 2-3 months prior to surgery and remain nicotine free for 3 months after surgery to optimize healing.  It’s essential to have your diabetes controlled and stop using nicotine products before and after surgery.  Otherwise, your risk of skin and tissue necrosis and open wound is extremely high that surgery should not be pursued.  Hypertension must also be well controlled because of high risk for bleeding and hematoma after surgery if blood pressure remains high.

What is the recovery?

Patient typically goes home on the same day.  Overnight night stay may be necessary in some cases.  Pain is controlled with pain medication and typically patients only take tylenol and ibuprofen after 2-3 days.  Bruising usually resolves by 2 weeks, but swelling can take 6-8 weeks to resolve.  The drains remain in place for 1-2 weeks.  Most patients feel back to base baseline around 1 week.  Abdominal binder or compression garment is worn for about 6 weeks to help reduce swelling and improve the contour.  Walking is extremely important immediately after surgery to reduce risk of blood clot forming in the legs.  Having assistance at home to help you move around and walking is essential to your recovery.  Strenuous exercise is not recommended for at least 6 weeks.

What are the complications of a panniculectomy?

As with any surgery, there is risk of bleeding, infection, hematoma, fluid collection despite drain placement and after drain removal, tissue necrosis, open wound, contour deformity, scarring, asymmetry, decrease or no sensation in the surgical area, and need for further surgery.  One of the most serious complications is blood clot forming in the legs and traveling to the lungs.  Hence, it is extremely important to mobilize and walk immediately after surgery to reduce this risk.  It’s essential to have your diabetes controlled and stop using nicotine products before and after surgery.  Otherwise, your risk of skin and tissue necrosis and open wound is extremely high that surgery should not be pursued.