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Body Lift - Panniculectomy

 

                           Panniculectomy Surgery

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A panniculectomy is a surgical procedure that gets rid of the excess fat and skin that may hang down over the genital area and thighs. This excess skin and tissue is known as the "pannus" or abdominal apron, and normally happens as a result of massive weight loss. The extra fat and skin in these areas tends to be more than a "just a cosmetic problem" - as it can cause back complications, skin chaffing, rashes and skin ulcers.

Tummy Tucks or Abdominoplasties are a different surgical procedure from a panniculectomy.  With an abdominoplasty, not only is skin and fat removed, but repair of the rectus abdominal wall muscles is normally performed. Patients undergoing abdominoplasty usually do not have the same symptoms and functional problems associated with this massive pannus  With a panniculectomy, only skin and fat is removed.

A Belt Lipectomy is also different from an abdominal panniculectomy. The belt lift is done with an incision that goes around the entire belt-line of the waist - across the lower portion of the abdominal wall and down the inner thighs and around the back. This procedure is considered a "circumferential incision" around the waist and back.

 

 

 

 

The fat and skin apron or what is called the abdominal panniculus is graded according to its size and extent the sagging tissues hang down. The higher the grade, the more extensive the surgical procedure that will be needed which can increase complications.

  • Grade 1 - Pannus apron reaches hairline and mons pubis - but not the private areas

  • Grade 2 - Pannus apron reaches private areas level with the upper thigh crease

  • Grade 3 - Pannus apron reaches upper-thigh

  • Grade 4 - Pannus apron reaches mid-thigh

  • Grade 5 - Pannus apron reaches knees


The higher grades of the Pannus Grading System have more problems after the procedure.

The higher the grades may also be associated with:

 

 

                                        Before and After Panniculectomy Procedure

                                               Copyright 2010 ASAPS - Used with permission

                                         Image of a Panniculectomy - Before and After

                                               

                                      

 

 

 

 

According to the ASPS - American Society of Plastic Surgeons, a patient should wait at least one full year after weight loss surgery - for the panniculectomy procedure. There are significantly fewer complications with patients who wait a year than those who decide to get a panniculectomy sooner.  Significant weight loss patients tend to have underlying physical conditions such as high blood pressure, diabetes, etc. Patients who wait a year between surgeries are much healthier going into surgery for the panniculectomy.

A panniculectomy is normally performed in a hospital or an outpatient surgery center. General anesthesia will be administered to the patient, as this procedure is complex. The actual amount of time that will be scheduled for this procedure will be dependent on the amount of skin and fat that is present. 

A panniculectomy removes skin only. If you need to have any kind of muscle repair done, then an abdominoplasty or tummy tuck will be done at the same time. There are some patients that need to stay in the hospital for a couple of nights after having this procedure.

 

 

 

 

Panniculectomy surgery affects a very crucial part of your body. Though risks and complications they’re rare, they do exist and can include - infection, bleeding under the skin flap, or blood clots. You may carry an increased risk of complications if you have poor circulation, diabetes, or heart, lung or liver disease.
 

Panniculectomy risks include:

 

Complications from an infection may be associated with graft placement with the repair of a hernia as well as skin infections such as cellulitus or erythema

  • Cellulitis - is a spreading bacterial infection of the skin and tissues beneath the skin. Cellulitis usually begins as a small area of tenderness, swelling, and redness.

  • Erythema nodosum -  is an inflammatory condition of the skin and underlying fat.

These two skin infections must be immediately attended to, usually requiring IV antibiotics in a hospital. 

 

The scarring with the panniculectomy procedure can be significant, however; scars tend to be a trade off for most patients with the massive amounts of skin and tissue that is removed with the procedure. Each patient is unique with their collagen production and hereditary, making scars hard to predict with how they will heal. Keloid and hypertrophic scarring can occur sometimes, however; there are many new and innovative treatments to help reduce these types of scars. 

 

It is not uncommon for large panniculectomies to have revision surgery - especially if the patient is asking for more contours to be done to the upper abdominal area, thighs, and hips. Most surgeons like for the patients to wait a minimum of six months before any revision surgery is done to reduce not only the anesthesia risks but also to reduce the incidents of necrosis occurring from the skin flaps. Revision surgery includes either abdominoplasty and or liposuction of lower body area - including the areas of the hips and flanks.

 

 

 

 

A panniculectomy is an extensive surgical procedure where the recovery is major, with taking several months for the wounds to heal completely. Surgical drains will be inserted into the incisions to help reduce any swelling or edema. The patient will need to record how much drainage is occurring, so your surgeon can keep track of how you are healing. The drains are removed when the output of the fluid is low.

Your surgeon will give you pre and post operative instructions. It is very important that you do everything your surgeon has stated.

If drains are used post operatively, you more than likely will have to take sponge baths until they are removed.  A compression garment will be given to you for support and comfort.

The post operative pain will be managed either by a pain pump or oral narcotics. Take the medication as prescribed, so there is no break through pain.  You will also be prescribed antibiotics and also something for nausea.

Exercise will be limited for several weeks. There is to be no pressure on the abdominal area after surgery, so no heavy lifting, etc.  Your surgeon will have a list of what you can and cannot do before and after your panniculectomy procedure.

 

 

 

 

There are some insurance companies that will pay for a panniculectomy - if it is considered medically necessary.  You will have to check your own individual policy limits regarding this issue.  Submitting documented proof of medical necessity and having it approved by your insurance company is imperative.

 

                                  Health Insurance Policy

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Every single policy will have their own requirements - however; most insurance companies will cover a panniculectomy procedure if it fits the following guidelines:

  • The pannus apron is a Grade 2 or more

  • You have lost 100 pounds or more and have been at a stable weight for at least six months

  • If a weight loss procedure was performed, such as gastric bypass, the surgery was at least 18 months ago

  • Documented history of rashes or non-healing skin ulcers for at least three months

  • The pannus apron causes difficulty with walking, sitting or standing and interferes with daily life activities

 

 

 

 

 

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