Panniculectomy

Who is a candidate?

The abdomen goes through changes with weight gain, weight loss, pregnancy, and aging. Common reasons for having a panniculectomy include:

  • Excess loose skin on lower abdomen
  • Stretch marks on lower abdomen
  • Rashes or open wounds below skin folds
  • Interference with hygiene
  • Interference with walking (if it hangs really low)

Is panniculectomy covered by insurance?

Insurance may pay for a panniculectomy cost (removing an overhanging “apron” of lower abdominal skin) if you meet specific criteria laid out by your specific insurance plan.

Typically insurance plans require that the abdominal pannus hangs below the level of the pubis, that the patient has had recurrent rashes not controlled by at least 6 months of conservative treatments (such as powders, creams, garment changes, girdles, etc).

Interference with hygiene and walking are also considerations.

Basically the insurance company must feel it is a medical necessity, rather than cosmetic improvement, if they are to offer pre-authorization of the procedure.

Of course, even with pre-authorization there is no guarantee they will pay, though they are much more likely to.

Panniculectomy versus Abdominoplasty (Tummy Tuck)

Panniculectomy in the strictest definition of the word is simply removing the overhanging apron of lower abdominal skin.

In this definition, a wedge of skin and tissue is remove, nothing is done to the widened muscles, the belly button is left as is, so literally the only thing that changes is the lower pannus is removed. 

Panniculectomy does not provide the best available look to the abdomen, since that is not it’s purpose.

Some surgeons will modify the strict definition and instead relocate the belly button, and/or fix the muscle widening (rectus diastasis), but in reality these procedures fall more under the domain of having a tummy tuck.

During a tummy tuck, a horizontal incision is made more or less hip to hip, the skin and underlying tissue is raised to the level of the border of the ribs and the xiphoid (lowest part of sternum), the rectus muscles are brought back together in the middle, the belly button is brought out through the skin at it’s new location, and the extra lower abdominal skin is removed.

Often patients have all of the medical complaints to qualify for panniculectomy, but want to have a tummy tuck for the best appearance.

In these cases, the procedure is considered part insurance, part cosmetic, and ends up saving the patient money since part of the procedure’s fees are covered by insurance, including part of the anesthesia and operating room fees.

If you are considering this type of procedure, the best thing to do is come in for a consult, let our office sort out your benefits and submit for preauthorization on your behalf, and go from there.

Risks of panniculectomy

The standard surgical risks include pain; bleeding; infection; scarring; painful or hypertrophic scarring; hematoma; seroma; injury to vessels, nerves, bowel, surrounding structures; asymmetry; poor cosmetic result; prolonged edema, numbness, parasthesias; fat necrosis; loss of all or part of umbilicus; deep venous thromboembolism; pulmonary embolism; death; need for further procedure and out of pocket costs; and risks of anesthesia.

Panniculectomy after Massive Weight Loss

Patients who have panniculectomy are often patients who have undergone massive weight loss.

In general, massive weight loss patients tend to have a greater risk of the  problems above, specifically with wound healing, possibility of an open wound, stretching of the skin after surgery, risk of infection if lengthy operating room time, and possibly more complications related to anesthesia in patients with a high BMI (body mass index).

Massive weight loss and nutritional deficiencies really take a toll on the skin and tissues.

Dr. Patel has had excellent experience taking care of patients who have undergone all types of weight loss surgeries.

Postoperative follow-up visits

Visits following surgery typically occur the day after surgery (for dressing change and making sure there was no bleeding, fluid collection, or blood supply issues overnight), the week after surgery (for removal of drains if present), 2 weeks after that, and then spread out less frequently thereafter.

The schedule is adjusted based on doctor/patient preferences and needs.

Recovery time

Walking the day of surgery, with assistance as needed, is required. One night stay in an aftercare facility, or private duty nursing at your home or hotel, is also required for the night of surgery.

Nurses will assist you in getting up and walking, teach you how to take care of your drains and dressings, and give you injectable pain and/or nausea medication if you are not eating enough to take oral medications, or if oral medications are not enough to keep you comfortable.

Often patients with young children or a hectic home schedule find it easier to recover at the aftercare facility, and stay for additional nights to recover and heal in a peaceful environment.

You may shower 24 hours after the drains have been removed. No baths, soaking in tubs, hot tubs, or swimming pools until incisions are fully healed.

Gentle soap (non-perfumed, non-irritating soap preferred) and water over the incision is okay. Scar gel may be used starting 2 weeks after surgery or once incisions have no open areas, crusting, or scabs.

An abdominal binder is placed at the end of surgery, and wearing it 24 hours a day is recommended for the first 2 weeks following surgery, and then it should be used as needed during periods of activity or as needed to help minimize swelling.

In general, Dr. Patel recommends avoiding exercise and heavy lifting (>15 pounds) for 6 weeks following surgery, at which time you can ease back into your workouts.

Light activity that does not involve working your core is okay (such as normal walking, but not speed-walking). Activity should be limited to small periods with adequate rest in between.

You may return to work 2 weeks after surgery, depending on your pain level, stamina, and activities required in your occupation. Often patients like to take more time off due to lifting restrictions, length of work-day, or comfort level with returning to work.

You may drive once you are no longer taking pain medications or muscle relaxers, and allow a 24 hour minimum window between your last pain medication or muscle relaxant dose and driving.

If you notice any pain and or swelling in the legs (especially if only on one side), you should notify Dr. Patel and report immediately to the emergency room to make sure you do not have a blood clot, which can be life-threatening.

All recovery processes and recommendations vary patient to patient, so these general guidelines may not apply to every patient.