A panniculectomy is a procedure that works to remove the loose, hanging fat and skin that commonly develops after an individual has lost a significant amount of weight. This hanging fat and skin (referred to as a pannus) usually takes the shape of an apron and can range greatly in size and severity.
Panniculectomy is usually recommended to people who have lost 100 lbs or more in a relatively short amount of time. The procedure can be carried out on its own or used in combination with abdominoplasty depending on a patient’s condition, and may be covered by OHIP. Regardless of the form the panniculectomy takes, ideal candidates should have maintained a relatively stable weight for roughly a year prior to surgery and be adhering to a regimen of exercise and healthy eating. Surgery is usually indicated once the person’s BMI (body mass index) is less than 30. Dr. Edelstein considers a panniculectomy to be exactly what the term describes: removal of the pannus. Only what is hanging down below the patient’s waistline is removed, and no undermining on the abdomen itself is performed. Dr. Edelstein does not advocate a panniculectomy alone except in extreme circumstances, when a patient’s expectations can be fulfilled.
Patients with a large pannus (extending as low as the knees, over the hips and/or around the back) may be afflicted by conditions including back problems, trouble walking or standing, rashes, ulcers and skin breakdown or other disorders. A panniculectomy can remedy these problems.
Abdominoplasty or Panniculectomy?
Most people have heard of a tummy tuck but may not know how it differs from a panniculectomy. The main difference between the two is that an abdominoplasty typically involves muscle tightening alongside the removal of excess fat and skin over the entire abdomen, while a panniculectomy works to remove only the overhanging skin and fat below the fold (the “apron”), without affecting the muscles.
Best results are usually obtained using a combination of Panniculectomy and Abdominoplasty, along with supplementary liposuction.
A panniculectomy may also be performed in conjunction with other abdominal surgical procedures. Patients who require a hysterectomy, abdominal wall repair or treatment for hernia of the belly button may combine these procedures with a panniculectomy.
Different Degrees of Pannus
Depending on how much weight a patient has lost, their pannus can range in size from as small as five pounds to as large as 120lbs. An abdominoplasty surgeon uses a grading system to classify the size:
Grade 1: The pannus extends to the pubic hairline and mons pubis (fat pad over the pubic bone), but does not reach the genitals.
Grade 2: The pannus covers the genitals and hangs in line with the crease of the upper thigh.
Grade 3: The pannus extends to the upper thigh.
Grade 4: The pannus reaches the mid thigh.
Grade 5: The pannus covers the knees or lower.
What Is The Procedure For A Tummy Tuck To Treat The Pannus?
General anaesthesia is administered.
A horizontal incision is made at the pubic area, usually from one side to the other (‘hip to hip’). Dr. Edelstein uses this incision to carefully remove excess fat and skin hanging below the waistline, before pulling the remaining skin together, closing the incision site. Drains are usually inserted.
Panniculectomy requires several hours of surgery and a hospital stay that can range from as little as one day to as long as a week.
Risks and Important Notes
The American Society of Plastic Surgeons has conducted studies demonstrating significantly fewer complications in patients who wait at least one year after bariatric surgery to receive a panniculectomy than those who are treated sooner.
Patients who allow their body time to recover after weight loss surgery are better able to lower their blood pressure, reduce stress on their heart, better control diabetes and improve their general health. Undergoing a panniculectomy sooner than six months after weight loss surgery also provides the risk of the patient losing further weight and possibly requiring a secondary panniculectomy operation to treat additional loose skin/fat.
As with any major surgery, panniculectomy complications are possible. Patients who experience bleeding, infection, or leg pain / swelling must contact their abdominal surgeon immediately.
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