A panniculectomy is surgery to remove excess skin from the lower abdomen. It is different from a tummy tuck, which is a cosmetic procedure that removes excess skin and fat and tightens the abdominal muscles.
A panniculectomy is elective surgery performed to relieve symptoms from an overhanging apron of skin. The excess skin can irritate and interfere with everyday activities. It's usually the result of significant weight loss.
This article discusses what a panniculectomy is and when it's recommended. It also covers what to expect during surgery and recovery.
What Is a Panniculectomy?
A panniculectomy is the surgical removal of stretched-out, overhanging skin and fat from the lower abdomen (such as the pannus or apron).
The surgeon makes a horizontal incision above the pubic area between the hips. They may make another cut from the breast bone to the pelvic bone to remove the fat and extra skin.
The surgery may be performed as either an inpatient or outpatient procedure. You and your surgeon will schedule this elective surgery if you are determined to be a good candidate.
A panniculectomy is considered a form of body contouring as it does result in a slimmer abdominal area. However, skin removal surgery is only intended to remove the extra skin and fat and is not considered cosmetic surgery.
If you're looking for tightening of the abdominal muscles in addition to removing fat and skin, you might consider an abdominoplasty (tummy tuck) instead.
Who Should Get a Panniculectomy
Your healthcare provider may recommend a panniculectomy if you have excess skin and fat on the lower abdomen that hangs over your thighs.
Excess skin can be caused by weight loss through gastric bypass surgery or lifestyle changes. It may also be caused by aging, prior surgery, pregnancy, or heredity.
It can cause sores and rashes and interfere with daily activities like walking or personal hygiene. A panniculectomy can help prevent recurring skin irritations and infections underneath the skinfold.
You may not be a good candidate for panniculectomy if you have another medical condition that's not well controlled. This can include diabetes, cardiac disease, lung disease, and autoimmune diseases. Obesity may also raise your risk of complications. You may also not qualify for skin removal surgery if you smoke.
Panniculectomies are often performed on adults and, in some cases, adolescents following bariatric surgery for weight loss. You should generally be at a stable weight for six months before undergoing a panniculectomy.
If you’re planning to lose more weight, your healthcare provider will likely suggest postponing the surgery until your weight has become stable.
Does Insurance Cover Plastic Surgery?
If you aren't a good candidate for a panniculectomy, your healthcare provider may recommend alternative procedures, such as an abdominoplasty. This procedure removes unwanted skin and fat and tightens the abdominal muscles.
Some people may also be better candidates for liposuction. Liposuction is used to improve the appearance of loose, fatty skin.
The risks for a panniculectomy include:
- Loose skin
- Skin loss
- Nerve damage
- Poor wound healing
- Fluid buildup
- Tissue death
Risks of Having Any Surgery
How to Prepare
Before the skin removal surgery, you’ll schedule an appointment with the surgeon. This allows you to ask questions about the surgery, including the risks and typical results. In addition, you can ask about their medical background, including expertise and training in panniculectomy surgery.
You should also arrange for someone to bring you home after the procedure. You may wish to have someone stay with you for at least the first night after the procedure while you recover.
Cost and Health Insurance
Your panniculectomy may be covered by insurance if your condition causes medical issues such as rashes or ulcers that haven't responded to treatment. It also may be covered by your insurance plan if the excess skin interferes with daily activities and can be corrected with surgery. If your panniculectomy isn't medically necessary, you'll likely pay for it out of pocket.
If applicable, check with your insurance provider ahead of time to find out what will and will not be covered.
Your panniculectomy will likely be performed in a hospital or licensed ambulatory surgical setting.
What to Wear
Wear or bring loose-fitting clothing that you can easily change in and out of. You'll wear a hospital gown for the procedure.
Food and Drink
Follow your surgeon’s instructions about when to stop eating and drinking before the surgery.
Several days before the skin removal surgery, your healthcare provider may ask you to stop taking certain medications. For example, aspirin, Advil (ibuprofen), Jantoven or Coumadin (warfarin), other medications, and certain vitamsin could cause problems with bleeding. Ask your healthcare provider if you should continue taking any medications on the day of the surgery.
To avoid complications, let your healthcare provider know before the surgery if you’re taking any medications. This includes prescriptions or any over-the-counter (OTC) drugs, herbs, and vitamins.
What to Bring
Make sure you remember any paperwork and your health insurance card. Also, bring a change of clothes if you want a separate outfit to wear home or if you’re spending the night. Remember to make arrangements for someone to drive you home after the surgery.
Pre-Op Lifestyle Changes
Surgeons often recommend quitting smoking at least four weeks before surgery. Smoking reduces blood flow and oxygen. It can cause tissue death, delayed wound healing, blood clots, and life-threatening complications such as strokes.
To avoid complications, ask your surgeon about your risk before scheduling surgery.
The Benefits of Quitting Smoking Prior to Surgery
What to Expect on the Day of Surgery
Before the panniculectomy, a nurse will check your vitals and ask about your medical history. You’ll receive general anesthesia so that you are asleep and unable to feel any pain.
During the Surgery
An incision will be made that runs horizontally in the area between your belly button and the pubic area. Excess skin and fat will be cut out with a scalpel or other surgical instruments through the horizontal incision.
Sometimes, the surgeon will also make an incision that runs vertically if you have excess skin and tissue in the transverse (side-to-side) dimension.
The remaining upper abdominal skin is then pulled down, and the incision is closed with sutures. Thin tubes called drains may temporarily be inserted under the skin to prevent the buildup of fluids.
The procedure usually takes three to five hours to complete, depending on how much skin and fat are removed. Talk with your healthcare provider before the skin removal surgery to confirm the techniques used.
After the Surgery
You’ll be monitored in the recovery area after the panniculectomy. When you recover from anesthesia, you may be asked to get up and walk a few steps. Depending on the extent of your surgery, you may be able to go home that day when you’re medically stable. In some cases, you may have to stay at the hospital for up to two days.
Your incision will be covered with gauze dressing or bandages. After a day or two, your healthcare provider may have you wear an elastic support or compression garment to help support the abdomen as it heals.
Patients will experience pain and swelling for a few days after the procedure. Your healthcare provider will give you pain medication to help manage your discomfort.
If you have drains, your healthcare provider will give you instructions for care. This may include recording the amount of fluid in the drains and how to empty them.
Avoid strenuous activity for four to six weeks after the procedure. You will probably be able to return to work within about four weeks.
Your surgeon will let you know when to visit for a follow-up appointment. Removal of drainage tubes may be done at this time.
You'll likely experience pain, swelling, and bruising for days after the surgery. You may have some numbness and feel tired during this time as well.
To help take some pressure off the abdomen, try keeping your legs and hips bent while resting. Your healthcare provider may recommend waiting to shower until 48 hours after the surgery. It may take up to three months for the swelling to go down and for the wounds to completely heal.
If you have shortness of breath, chest pains, change in heart rate, or increased pain or swelling, contact your healthcare provider immediately.
Coping With Recovery
Skin removal surgery can help you feel more confident in your appearance, but it may take some time to get there after surgery. Patients can have significant scarring for more than a year after the surgery. It can take up to two years for scars to fade and to see the intended results.
Studies show those who have skin removal surgeries usually have an adjustment process but tend to be happy with the results.
One study found that patients were self-conscious about their scars and body image for the first year after body contouring surgery. However, those same patients reported improved body image after the first year and less distress about their scarring.
In another study, patients who had body-contouring surgeries were surveyed about their ideal body shape. Their perception of their appearance improved significantly with surgery, even if they identified a thinner shape as ideal. The results indicated they felt encouraged about their appearance and ability to reach their goals.
In a panniculectomy, the surgeon removes overhanging skin and fat from the lower abdomen. Usually, this happens after you've had dramatic weight loss, especially from gastric bypass surgery or lifestyle changes.
Your healthcare provider may decide you're a good candidate for the surgery if the excess skin is causing repeated irritation or infection. It's not recommended for purely cosmetic reasons.
A panniculectomy may be performed as an outpatient or inpatient procedure, and usually takes between three and five hours. It may take up to three months for the wounds to completely heal.
A Word From Verywell
Ask your healthcare provider any questions you have about the panniculectomy, your recovery time, and the results you can expect. Panniculectomy is a major surgery that can require weeks or months to fully heal. However, if you're dealing with extra skin after weight loss, surgery can help improve your health and quality of life.
Frequently Asked Questions
Is a panniculectomy the same as a tummy tuck?
No. They are similar procedures but are not the same. The panniculectomy removes excess skin and fat from the lower abdomen that has caused such problems as skin rashes, skin breakdown, or even difficulty walking. A tummy tuck (abdominoplasty) is a cosmetic procedure that removes extra skin and fat and tightens the abdominal muscles.
Is a panniculectomy considered reconstructive surgery?
Sometimes. A panniculectomy may be considered reconstructive surgery, especially if a significant amount of skin needs to be removed.
How much weight is removed in a panniculectomy?
The exact amount of weight removed in a panniculectomy can vary, depending upon how much skin and fat is removed. A previously published report stated the amount of weight removed from a panniculectomy ranged from 10 to 49 pounds.