Panniculectomy: Post-Bariatric Body Contouring

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A body contouring procedure known as panniculectomy can get rid of the excess fat and skin that may hang down over the genital area and thighs. Known as the pannus, this hanging fat and skin often occurs among people who have lost massive amounts of weight after bariatric surgery. Extra fat and skin in these areas is more than a cosmetic problem; it can cause back problems and skin chaffing, followed by rashes and skin ulcers.

A panniculectomy may be performed itself or in tandem with an abdominoplasty (tummy tuck). While a panniculectomy and a tummy tuck both target the abdomen, they are very different operations. Abdominoplasty removes fat and tightens the abdominal muscle, while a panniculectomy only gets rid of the pannus.

Sometimes, a panniculectomy is paired with a hysterectomy (removal of the uterus) or a hernia repair because surgeons are already operating in this region.

Are you a Candidate?

People who are obese or have lost a significant amount of weight through diet, exercise or bariatric surgery, as well as women who held on to their extra weight following pregnancy may be candidates for panniculectomy.

To be considered for panniculectomy, you should be at a stable weight for at least one year. People who have had gastric bypass or adjustable gastric banding surgery should also wait one year after surgery so that they are at a stable weight and any health problems linked to their obesity such as diabetes and high blood pressure have been corrected. (Read more about obesity and related health problems.)

Preparing For Your Surgery

Your surgeon will take a complete medical history and do a full physical to clear you for your panniculectomy surgery. He or she will want to know about any previous surgeries you have had as well as what medications (prescription, over the-counter and nutritional supplements) you take on a regular basis.

Your surgeon also will provide you with a list of things you should and shouldn’t take before surgery.

If you smoke, you should quit before your surgery. Smoking impedes the healing process and increases the risk of certain complications after a panniculectomy.

Understanding the Procedure

Your panniculectomy may be performed in a hospital or outpatient surgery center.

Your surgeon will likely use general anesthesia. The duration of the surgery will vary based on how much skin and fat is present and whether or not you are also having a tummy tuck, hernia repair or another abdominal surgery. It typically takes several hours. Plan to stay in the hospital for up to a week following a panniculectomy.

To perform the panniuculectomy, your surgeon will make two incisions. The first spans from the lower area of your sternum to your pubic bone. Your surgeon will then make a horizontal incision across the pubic area and remove the extra fat and skin. The remaining skin is pulled together and sutured.

Recovery

Panniculectomy is a major operation and the recovery process is significant. It may take several months for the wounds to heal completely.

Your surgeon will likely insert drains in the incision areas to help reduce swelling and get rid of excess fluid. These drainage tubes can be safely removed when the output of fluid is low. Your surgeon also will use tape to shore up the incision areas.

Make sure that you receive and understand your postoperative instructions.

You will need to take sponge baths for a predetermined period of time after the surgery. You also may be fitted for a medical compression garment for support and comfort.

You may experience discomfort, swelling and some bruising after your surgery. Your doctor can prescribe appropriate pain medications to help you feel more comfortable.

You will not be allowed to put pressure on the abdominal area for some time. This means no exercise or heavy lifting for several weeks after surgery. Talk to your surgeon to make sure that you are clear about what you can and can’t do after your panniculectomy surgery.

Risks

All surgeries have risks. Panniculectomy risks include:

Infection
Bleeding
Excessive scarring
Fluid collection (seroma) in the newly created abdominal space
Blood clots in the leg or lungs
Revision surgery

Consult a Qualified Plastic Surgeon

If your surgeon is board-certified by the American Board of Plastic Surgery, he or she has extensive experience performing the chosen surgery. Proper board certification ensures that the surgeon has completed specific and rigorous education and training.

Thoroughly review your surgeon’s credentials including his or her educational background and training. Ask about board certification as well as how many times he or she has performed a panniculectomy as part of this process.

Ask to see plastic surgery before and after photos of people who have had a panniculectomy at the practice.

Costs

The cost of a panniculectomy comprises local or general anesthesia fees, facility fees and surgeon’s fees.

You will not be billed separately for anesthesia or facility fees if it is performed at the same time as an abdominoplasty or other surgery. The plastic surgery costs of a panniculectomy can range from $8,500 to $10,000 depending on how much skin is removed and whether it is paired with another operation.

Insurance may cover the cost of the surgery if it is deemed medically necessary. For example, if the pannus is causing recurrent skin infections or back pain, your insurer may pay provided you receive preauthorization. An insurer will likely cover the cost of medical procedures such as hernia repair or hysterectomy, which may be coupled with a panniculectomy. Insurance coverage of elective procedures is not reserved for bariatric surgery procedures like panniculectomy.

If you cannot afford to pay for a panniculectomy, discuss payment plans and patient financing options with your surgeon.

Further Reading:

About the Reviewers of This Article

Munish K. Batra, MD, FACS, has a leading cosmetic surgery practice in San Diego, Calif. Dr. Batra is certified by the American Board of Plastic Surgery and the American Board of Surgery. He specializes in all facets of plastic surgery regarding the face, body and breast, including reconstructive and laser procedures. Dr. Batra earned his medical degree from Case Western University and completed his plastic surgery training at University of California – San Diego Medical Center, with additional fellowship training in advanced facial surgery.

Marialyn J. Sardo, MD, FACS, is a board-certified plastic surgeon in San Diego, Calif. She received her medical degree from the University of California, San Diego School of Medicine. Dr. Sardo trained in general surgery at the University of California, Los Angeles and Cedars-Sinai Medical Center. She received her training in plastic and reconstructive surgery at Boston University Medical Center.