What is a Panniculectomy?

A panniculectomy is a surgical procedure that removes excess skin and fat from the lower abdomen. Typically, patients undergo a panniculectomy or a tummy tuck after massive weight loss surgery.

During a panniculectomy, excess hanging skin and fat is removed. This is the skin that hangs over the pubic region. Only the excess skin and fat is removed. In comparison, during a tummy tuck,excess abdominal skin is removed from the pubic region to above the belly button and sometimes beyond. Also, the abdominal muscles are tightenen and the location of the belly button is either reconstructed or relocated. One common misconception is that panniculectomies and tummy tucks are the same. They are not. A tummy tuck is more of a cosmetic, aesthetic plastic surgery procedure whereas a panniculectomy is more of a reconstructive and medically necessary plastic surgery procedure. To know which procedure is best for you, and to know which type of candidate you are, here is what you need to know. Patients who have fat and skin extending below their knees, over their hips, pubic region, and around the back. If you have rashes, ulcers, or skin conditions, you also be a good candidate for a panniculectomy. Patients who have the above conditions, but are also looking to enhance the contour of their upper abdomen and their overall physical appearance, may be good candidate for an abdominoplasty, or a tummy tuck.

How to Know if I Am a Candidate To know if you are a candidate for either a tummy tuck or a panniculectomy, it is best to do the “knees test”. If you have skin and fat extending to your knees, you are more likely a candidate for a panniculectomy. If you have excess skin and fat hanging from your lower abdomen and the excess partially or totally covers the pubic region, you are more likely a good candidate for an abdominoplast. If you are unable to determine or are unsure which procedure to undergo, if you have rashes, ulcers, or any skin disorders on the hanging skin, a panniculectomy or tummy tuck may need to be performed. Something to keep in mind, while a panniculectomy may be covered for by insurance, a panniculectomy does not provide the best aesthetic or best look for the abdomem. The panniculectomy also does not tighten the abdominal muscles. The purpose of a panniculectomy is to remove the pannus (hanging skin) and potentially alleviate low back pain or discomfort you may have. For a tummy tuck, usually the incision is made horizontally on the lower abdomen. The abdominal muscles (rectus abdominis) is tightened. The tummy tuck is designed to aesthetically improve the abdominal contour and to remove excess abdominal skin and fat Now that you have determined that a panniculectomy is what you need, it is time to schedule a consultation with Dr. Katzen.

Before the Panniculectomy Procedure Once your consultation is scheduled, you and Dr. Katzen will discuss your goals and what you should expect during and after the panniculectomy surgery. During this time, you and Dr. Katzen will thoroughly discuss your medical history and what you expect from panniculectomy surgery. Once everything is discussed in the consultation room, it is time to schedule a surgery date.

During Panniculectomy Surgery The panniculectomy surgery should be performed by a plastic surgeon in an outpatient surgery center hospital. Panniculectomy surgery may last several hours depending on how much skin and fat needs to be removed. The panniculectomy is performed under general anesthesia and requires one or two nights, nights stay at a hospital or outpatient facility. Before surgery starts, Dr. Katzen will go over any last minute questions and make his surgical markings. After that, the surgical nurse will prep you and Dr. Katzen’s anesthesiologist will go over with you what you should expect being under anesthesia. The anesthesiologist will then take you to the operating room, where he or she will administer general anesthesia. An incision is made under the lower area of the abdomen, (underneath the pannus or hanging abdomen). The incision placement also depends on the pannus’s anatomy and how it needs to be removed. After a Panniculectomy After the panniculectomy surgery is done you will wake up to a new body. Yes, that new body is yours to keep. Dr. Katzen will provide you with a list of general post-op questions and answers to maximize your healing. It is important to follow Dr. Katzen’s post-op instructions so you have a smooth and speedy recovery. Following the panniculectomy surgery, Dr. Katzen will place a specialized body garment on you for compression and to help and minimize swelling. To minimize swelling and maximize results, the body garment should be kept on for about six to eight weeks. You will need assistance during your recovery. You should expect about one to two weeks for a full recovery. After two weeks, depending on you have healed, you may return to work. Dr. Katzen also suggests to limit heavy activity. No baths or showers until the wound is completely healed. You may shower after the drains have been removed. Dr. Katzen also suggests while you should give yourself a 24-hour window before operating a vehicle, as pain medication and muscle relaxants may impair your driving. If you notice abnormal swelling and pain, please notify Dr. Katzen immediately.

Insurance vs. You The cost of a panniculectomy and a tummy tuck vary greatly. Whether you decide to pay for the panniculectomy or tummy tuck out of your own pocket or have your insurance pick up the bill, here are some things to consider. Most insurance companies will ask, “is this procedure medically necessary?”. That is their “determining” factor if the insurance will pay or not. As stated above, panniculectomies are commonly medically necessary. They are mostly medically necessary because of rashes, skin conditions, and or pain. Insurance companies are more willing to pay for a medically necessary procedure rather than a cosmetic procedure like a tummy tuck, or abdominoplasty. If you are interested in a panniculectomy or tummy tuck procedure, please call the office (310) 859-7770.