Panniculectomy

What is a panniculectomy?

A panniculectomy is a surgical procedure that removes extra skin and fatty tissue from your lower abdomen. Skin may hang from your stomach (abdomen) over your hips, genitals, thighs or knees. This is called a pannus or apron, as it resides where an apron would be if you wore one on your body. 

A panniculectomy may smooth (contour) your stomach, but it doesn’t tighten your muscles like a tummy tuck. This procedure isn’t a type of weight loss surgery, however, it can help you manage excess skin before or after weight loss.

What does a panniculectomy treat or manage?

A panniculectomy helps manage symptoms caused by excess skin around your abdominal region.

When skin folds over, it rubs against other areas of skin. As a result, these areas can be challenging to clean or keep dry. This creates ideal conditions for certain fungi or bacteria to grow. 

The friction from frequent skin-to-skin contact may cause sores and rashes. Excess pannus tissue may also affect your ability to walk, bend over or perform other physical activities. You might experience lower back pain, too.

You may develop excess skin as a result of:

• Natural changes to your body as you age
• Pregnancy
• A previous surgery
• Significant weight gain or weight loss

Is a panniculectomy a high-risk surgery?

A panniculectomy is a major surgery that comes with possible risks. Your care team will take all precautions to make sure you’re a good candidate for the procedure and that it’s safe.

Who is a good candidate for a panniculectomy?

In general, you may be a candidate for a panniculectomy if you

• Have pannus tissue that hangs over your hips, genitals, thighs or knees
• Are in good health and maintained a steady weight for at least six months
• Don’t have a medical condition that affects your body’s healing ability
• Don’t smoke
• Have realistic expectations about the outcome of surgery

Your surgeon will verify that you’re a candidate for this procedure. If you’re worried you may not be qualified for this type of procedure, your provider may have other suggestions to help you reach your goals.

How should I prepare for a panniculectomy?

Before a panniculectomy, you’ll meet with your surgeon. They’ll evaluate your general health, including any preexisting health conditions, and discuss your expectations for the procedure. Your provider may take photographs of your abdomen from the front and the side (profile) for your medical record.

Tell them about any previous surgeries you’ve had, as well as any prescription or over-the-counter medications you take, including herbal supplements. Aspirin, anti-inflammatory drugs and certain herbal supplements may increase your risk of bleeding.

They’ll also examine the size of your pannus and grade it depending on how far it hangs from your abdomen.

Your provider will also give you specific instructions to follow before the date of your surgery. This may include:

• Making changes to the medications you take (don’t make changes unless your provider approves them)
• Not eating the night before surgery
• Getting certain tests done
• Not smoking

If you have any questions about the procedure or what to expect, make sure you ask them before the date of your procedure.

What happens during a panniculectomy?

You can expect the following during a panniculectomy:

1. An anesthesiologist will give you general anesthesia. This will put you to sleep so you won’t feel any pain.
2. Your surgeon will make a cut (incision) just above your pubic area. The cut extends out toward your hips. The size of this incision depends on how much skin your surgeon will remove.
3. Your surgeon will pull down your skin above the incision and remove any excess skin. Depending on the size of the pannus, the procedure may pull down or completely remove your belly button (navel). Your provider may or may not need to reposition and stitch your navel back into place.
4. Your surgeon will pull your skin together and stitch the incision site closed.
5. Your surgeon may place small tubes in your abdomen to drain any blood or fluid.

How long does a panniculectomy take?

The time it takes to complete this procedure depends on many factors. It may take from one to three hours. Your surgeon will give you the best time estimate.

What happens after a panniculectomy?

You’ll move to a recovery room, where healthcare providers will wait for you to wake up and monitor your overall health.

A provider will cover your incisions with bandages. They may also wrap your abdomen with an elastic bandage or a compression garment after surgery or later in your recovery. This helps minimize swelling and support your abdomen as it heals.

Most panniculectomies are outpatient procedures. This means you can go home the same day that you have surgery. You need to have a loved one drive you home and take care of you for at least the first 24 hours after the procedure.

What are the benefits of a panniculectomy?

There are many advantages to a panniculectomy, including:

• Improved hygiene. Washing your abdomen, genitals, hips and legs is much easier.
• Fewer rashes and other skin problems. With the excess tissue removed, you’ll have less friction. This should reduce the number of rashes and sores you get in this area.
• Improved mobility. Physical activity should get easier.
• Less pain. After healing from your panniculectomy, you should have less lower back pain.
• Self-esteem boost. Most people like the results of their panniculectomy.
• Clothing. After surgery, your clothing may fit more comfortably.
• Permanent results. Your body’s new shape (contour) will be permanent if your weight remains stable.

What are the risks of a panniculectomy?

All surgical procedures carry some risk. For a panniculectomy, this may include:

• Blood loss
• Pain
• Anesthesia reaction
• Infection
• Mass of clotted blood (hematoma) or an accumulation of fluid (seroma)
• Numbness
• Wound healing delays
• Skin discoloration
• Swelling (edema) of the abdomen and/or legs
• Unfavorable scarring
• Unbalanced (asymmetrical) abdomen
• Your skin becomes loose again
• Need for possible additional procedures

What does a panniculectomy scar look like?

A panniculectomy scar may look different for each person. It varies based on the size and shape of your pannus and the results you hope to achieve. The scar shape is typically in a line (linear). It usually runs across your lower abdomen, from hip to hip. A fleur-de-lis panniculectomy may leave a “T” shaped scar in your lower abdominal region if your surgeon uses this type of incision.

The scar may fade gradually over several months to a year, but it’ll never disappear completely.

What is the recovery time after a panniculectomy?

The first several days after a panniculectomy are often the most painful. You may feel swollen, bruised and sore. Your incisions may bleed slightly. You may feel more comfortable wearing an elastic wrap around your abdomen, but check with your surgeon before doing so.

After five to seven days, your pain and discomfort should begin to decrease. You may take either a prescribed pain medication or over-the-counter acetaminophen (Tylenol®) to manage pain. As always, discuss your allergies and complete medical history with your provider before taking any medications. 

Your provider will check your incision site and attend to your stitches and your drains after about a week or two. Deeper sutures will remain or dissolve on their own.

After one to two weeks, you should be able to return to light daily activities, including desk work. But you should avoid strenuous physical activity for at least six weeks. You may still have some bruising and pain.

It may take at least six months for your incision site to heal completely.

It’s important to remember that your body is unique, so recovery times may vary. Follow your provider’s instructions on managing your pain and discomfort.

When can I go back to work or school after a panniculectomy?

Depending on what you do, you should be able to go back to school or work about two weeks after a panniculectomy. Often, you may be restricted to “light duty.” If you have a physically demanding job, you may need more time to recover before returning to work.

When should I call my healthcare provider?

Your provider will schedule regular follow-up appointments with you after your procedure to make sure you’re healing as expected. Let them know if you notice signs of an infection like redness, severe pain or fever.

Contact your provider immediately if you experience any abnormal symptoms after your panniculectomy, including shortness of breath, chest pains or an irregular heartbeat.

What happens if you gain weight after a panniculectomy?

Gaining a few pounds won’t cause much of an issue after a panniculectomy. But drastic weight changes may cause the pannus to form again. This may require a repeat surgery. There isn’t a specific amount of weight that causes this for everyone, since each person’s body is different.

Your provider can help you maintain a weight that’s healthy for you to keep your results.