What is a Panniculectomy?
The panniculus, sometimes called the pannus is a dense layer of fatty tissue in the lower abdominal area. It consists of subcutaneous fat, and is often the result of obesity. The panniculus sometimes becomes large enough to hang at the level of the mons pubis (the top of the pubic area), or even, in some extreme cases, to a person's knees. This also results in the abdominal skin being stretched.
A panniculectomy is an alternative to a tummy tuck. The procedure entails removing the excess fat and stretched skin that make up the panniculus. The main difference between the two procedures is that a panniculectomy does not include tightening the abdominal muscles.
The Best Candidates for Panniculectomy
The size of a panniculus varies from person to person. It can fall to just above the pubic area, to the upper thigh, or even to the knees. The degree of severity depends on the weight of the person, and more importantly, how much weigh that person has lost, thereby leaving behind a panniculus that consists mostly of stretched-out skin.
This extreme weight loss can be a result of a vigilant regimen of diet and exercise, or it may occur by means of gastric bypass surgery. Additionally, some women who have experienced one or more pregnancies may develop a panniculus. Those women may be candidates for a panniculectomy, but are more often better suited for abominoplasty.
A severely large panniculus is also sometimes called an apron of tissue. This apron can cause several problems for a person, such as back pain, rashes, and even infections and ulcers in the skin folds. It can also interfere with personal hygiene, mobility, and how clothing fits, not to mention it may be difficult to find clothing large enough to accommodate the panniculus.
A panniculus of this size can also have a detrimental effect on a person's emotional well-being. They may feel embarrassed by how they look, or by not being able to perform everyday activities.
Because a panniculectomy can correct functional issues and improve health, it may be covered by health insurance. An added benefit will be improvement in appearance.
The best candidates for panniculectomy are in overall good health. They must have maintained a stable weight for more than a year. They must also wait one year after undergoing gastric bypass surgery. A panniculectomy candidate must also have realistic expectations about the potential results of the surgery, and have a post-surgical plan to maintain a healthy regimen of diet and exercise.
After removal, the panniculus can weigh anywhere from five pounds to more than 100 pounds, depending on its severity. There are five grades panniculus severity:
Grade 1: panniculus hangs at the level of the mons pubis
Grade 2: panniculus covers the full pubic area
Grade 3: panniculus falls to the upper thigh
Grade 4: panniculus reaches to the mid-thigh
Grade 5: panniculus extends to the knees
How is a Panniculectomy Performed?
First, we'll want you to come in for a consultation to discuss your case and make sure you're a candidate for panniculectomy.
The surgery is performed under general anesthesia, and normally takes between two and five hours to complete, depending on the size of the panniculus, and your particular anatomy. Also, if you choose to have other procedures done simultaneously, this can extend the surgery length.
First, the surgeon will make an incision that extends from one hip to the other. The excess fatty tissue and the stretched skin will be excised, and the remaining tissues and skin will be gently sutured together. Depending on the grade of the panniculus, it may also be necessary to make a vertical incision. Your navel may also have to be relocated so it sits properly in your newly flatted abdomen.
Your surgeon will place drains near the incisions to allow fluid to escape the surgery site. This helps to prevent seroma (fluid buildup), and infection. The drains will be removed after about a week.
If you have a hernia, this can be corrected at the time of the panniculectomy. You may also have other procedures performed at the same time, such as liposuction.
Panniculectomy Risks and Results
The degree of risk involved in a panniculectomy depends on the grade of the panniculus. The larger it is, the more at risk you may be for complications such as infection, seroma (fluid buildup), hematoma (blood clot), and necrosis (tissue death).
The recovery period is shorter than that of a tummy tuck because the underlying abdominal muscles are not treated.
After your panniculectomy, you'll have a flatter midsection, without the hanging apron of tissue. If you also had liposuction, your hips and waist may also be reduced, and you may have a more streamlined figure. Aside from appearance, with the panniculus gone, you should feel lighter, and any other effects you were suffering such as back pain or skin sores should also be alleviated.
As with any surgery, you may have some residual scarring. If this a concern for you, we'll be happy to discuss our scar removal procedures with you.