Many people who have lost a significant amount of weight are left with excess skin and fat that hangs down from the abdomen and extends into the pubic area and thighs. This abdominal overhang, called the pannus, is often found to cause discomfort and affect quality of life.
The pannus may make bathing more difficult, resulting in odor. Furthermore, sweating and chafing may result in increased susceptibility to rashes, irritation, and infections. (1)
This abdominal overhang may also make it more difficult to lead an active lifestyle and keep up with weight loss goals.
If you find that loose abdominal skin is affecting your quality of life, you may consider having a panniculectomy. A panniculectomy is a surgery that removes excess skin and fat.
If you are looking to remove the excess skin and fat hanging below your abdomen, a panniculectomy may be right for you. While the removal of this excess skin does flatten the abdomen, note that a panniculectomy does not tighten the muscle wall like an abdominoplasty (“tummy tuck”) does. (1)
An ideal candidate for a panniculectomy should: (1, 2)
- Maintain stable weight for at least 6 months after weight loss surgery
- Have good dietary habits
- Maintain a relatively active lifestyle
- Be a non-smoker
- Not have cardiac disease, lung disease or diabetes
- Have a body mass index of less than 40
- Have tried other treatments such as topical antifungals, corticosteroids and antibiotics but none of these treatments have worked
Prior to surgery, your doctor will go over your medical history and examine your abdomen to determine your eligibility for this surgery. Your doctor will ask you about previous surgeries and prescriptions you are taking. Some medications, such as aspirin, oral contraceptives and herbal supplements may affect the healing process and you may be advised to stop taking them before the procedure. (2)
The procedure will be performed in a hospital or outpatient surgery center. (4) You will likely be under anesthesia and the procedure will typically last 2-5 hours. (3)
The procedure will typically go as follows: (2)
- The panniculectomy will require one horizontal incision in your lower abdomen just above your pubic area. This incision will be determined based on the size of the pannus. A second vertical incision from the breast bone to the pubic bone may also be made if necessary. The doctor will remove the excess skin and fat through the incision sites. Your doctor may also need to make an extra incision to reposition your belly button. (4)
- The remaining skin will be closed together using staples, absorbable sutures or nonabsorbable sutures. Which of these your doctor uses will depend on your risk of infection or delayed healing. (2)
- Before the wound is closed, a suction drain may be placed under the flap to get rid of any excess fluid your body may accumulate while trying to fill this new empty space. (1)
After you wake up from anesthesia you may experience pain and swelling for a few days. You may need to stay at the hospital for 2 days after surgery. (5) During this time, your doctor will likely give you a compression garment that will provide you support while you are healing. (1)
Your doctor may advise you to remain bent at the waist for a week after surgery and then gradually try to stand upright. This will help ensure that your sutures do not break. (1)
Dressings will be applied at the surgical site and should remain clean and in place for 2-3 days. They should be changed every 2-3 days for the first 2 weeks after surgery. (7)
Your doctor will remove the drains 1-2 weeks after surgery. You will not be able to shower when the drains are still in place, but sponge baths are allowed. (7)
You can expect the swelling to go down and your wound to heal after 3 months . You will have a scar from the surgery, but it should fade within a year. (4)
You will need to avoid heavy lifting or strenuous activity for 4 to 6 weeks after surgery. After this time, you can expect to return to work and go about your normal routine. (5)
A panniculectomy, similar to any surgery, can result in complications.
Some of these complications can include: (2)
- Delayed healing
- Dead tissue
- Hematoma (bleeding that occurs outside of blood vessels)
- Seroma (collection of fluid that builds up under your skin)
- Wound reopening after surgery
People that have a body mass index over 40 may have increased risk for these symptoms. (2)
It may take a few weeks or months to start seeing results due to swelling that occurs after the surgery. This is normal. As a matter of fact, it can take up to 2 years to fully see the results of the surgery. However, most people are happy with the outcome of the procedure. (5)
You can expect that the final results from the panniculectomy will be maintained long-term if you continue to lead a healthy lifestyle with good diet and exercise.
A panniculectomy is often considered to be a medically necessary procedure because the pannus interferes with mobility and can cause infections and discomfort.
An abdominoplasty, or “tummy tuck,” also removes excess skin and fat but additionally focuses on tightening the muscle wall to achieve increased muscle tone and a slender body. (1) For this reason, sometimes people choose to do both of these procedures.
However, because an abdominoplasty focuses on appearance and is not medically necessary, it is considered a cosmetic treatment and tends not to be covered by insurance.
Here is a quick summary of some advantages and disadvantages of both procedures:
|Improves quality of life by resolving discomfort from excess skin and fat.||Often leaves hip-to-hip scar across lower mid-section.|
|Likely covered by insurance if medically necessary.||Will not tighten the abdominal muscles.|
Abdominoplasty (Tummy Tuck)
|Aesthetically trims and tightens the abdominal muscles for a firmer and smoother abdomen.||Procedure leaves permanent, yet well-hidden scar.|
|Removes or improves stretch marks, C-section, hysterectomy scars and lower back pain.||Likely is not covered by insurance.|
The cost for the panniculectomy ranges from $8,500 to $10,000. The cost typically includes fees for the surgeon, the anesthesia and the facility. (6)
Whether or not your insurance will cover the procedure depends on whether it is considered to be medically necessary or cosmetic.
To be considered medically necessary, usually the pannus must extend past the pubic area and may be causing issues with function. (1)
You should talk with your insurance provider to see what they will and will not cover for this procedure.
- Sachs D, Sequeira Campos M, Murray J. Panniculectomy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; September 5, 2020.
- Nahabedian MY, Nahabedian AG. Panniculectomy: Perioperative nursing considerations. Nursing. 2017;47(10):32-38. doi:10.1097/01.NURSE.0000524753.74764.5e
- Panniculectomy. University of Michigan Medicine Website. Accessed October 9, 2020. https://www.uofmhealth.org/conditions-treatments/surgery/plastic/cosmetic/body/panniculectomy
- Panniculectomy: body contouring. American Society of Plastic Surgeons Website. Accessed October 9, 2020. https://www.plasticsurgery.org/reconstructive-procedures/panniculectomy
- Panniculectomy. Medline Plus Website. Updated June 5, 2018. Accessed October 9, 2020. https://medlineplus.gov/ency/article/007739.htm
- Panniculectomy surgery – are you ready to lose the rest of the weight? Consumer Guide To Plastic Surgery Website. Accessed October 9, 2020. https://www.yourplasticsurgeryguide.com/tummy-tuck/panniculectomy/
- Panniculectomy post operative instructions. Kaiser Permanente Website. Accessed October 9, 2020. https://mydoctor.kaiserpermanente.org/ncal/Images/Panniculectomy_tcm75-154991.pdf