Dramatic weight loss can create its own problems. One of the main issues faced by people who have lost significant weight in a short time is excess stretched skin and leftover fat on their bodies. If left intact, the excess skin can lead to rashes, infections and other skin problems. This article explores panniculectomy, the procedure to remove excess skin and fat left behind in the stomach area after major weight loss. 

People try in so many ways to lose weight. Weight loss has its own industry, supported by the many people who seek ways to shed unwanted kilos, and the methods and products that claim to help people shed them. Sometimes those who try to lose weight succeed, a happy outcome that should be celebrated. But people who lose a lot of weight quickly may need additional help before they can actually enjoy their newfound figures. Dramatic weight loss—as a result of bariatric surgery or other radical weight loss methods—can leave behind a lot of excess skin. The most troublesome are skin folds that hang over the thighs and pelvic area. In some people these skin folds can extend as low as their knees, over their genitals, hips and around their backs, interfering with daily activities like walking, standing and sitting.

One way to avoid this problem, of course, is to lose weight slowly, allowing the skin to repair itself and shrink gradually. But that is not an adequate solution for many people. People who have achieved dramatic weight loss need help, and soon.

If nothing is done, the hanging folds of excess skin and fat can lead to serious health problems including:

• Back problems (due to weight and posture issues)
• Skin damage or breakdown of skin
• Rashes due to chafing
• Ulcers and abscesses
• Skin infections

Things to consider once you’ve decided to have a panniculectomy

Panniculectomy is a surgical procedure that removes hanging skin and fat. In other words, it is a procedure that helps contour the body by removing redundant tissue. A panniculectomy is often classified as reconstructive surgery rather than a cosmetic procedure, especially when it addresses physical functional impairment.

Panniculectomy gets its name from pannus, the Latin word for a hanging flap of tissue. When the pannus is on the abdomen, it is referred to as a panniculus. It typically consists of skin and fat, but can also contain material from an abdominal hernia.

Rashes, ulcerations, and infections that can develop in the abdomenal and pelvic folds are sometimes referred to as panniculitis.

A panniculectomy is different from an abdominoplasty or tummy tuck. A tummy tuck tightens the abdominal muscle and removes any excess skin and fat from the front of the body. A panniculectomy only removes skin and fat.

While panniculectomy can be performed on its own, it can also be combined with other abdominal surgery such as a tummy tuck (abdominoplasty). If necessary, panniculectomy can be performed together with surgery to repair the abdominal wall or to treat bellybutton hernia.

Panniculectomy is performed on both men and women.

You are a good candidate for panniculectomy if you have recently experienced significant weight loss as a result of bariatric surgery or a post-pregnancy complication that left excess amounts of fat below the belly button.

An ideal candidate for panniculectomy should have maintained a stable weight for one year leading up to the procedure. Surgeons recommend that people who have had Lap-Band surgery or a gastric bypass should wait for at least one year before a panniculectomy. This applies to other body contouring procedures as well, including corset trunkplasty and bra-line back lift.

What to expect

Panniculectomy is classified as abdominal surgery. An accredited surgeon should perform it in an approved facility such as a hospital or outpatient surgery center. The surgery can take several hours, depending on the extent of work necessary.

Most often the procedure is performed under general anaesthesia. It may require a hospital stay lasting anywhere from one to seven days.

The surgeon makes a vertical incision from the lower area of the breast bone (sternum) down to the pubic bone. A horizontal incision is made at the pubic area to allow the removal of excess skin and fat. To complete the surgery, the remaining skin is pulled together and the incisions are closed. Drains are inserted if necessary to remove excess fluids

Complete healing from a panniculectomy can take weeks.

Before and after surgery

There are several things you can do to prepare for any surgery and these apply to the panniculectomy procedure as well.

After surgery

There are general steps that can speed up the healing process after surgery. Follow these and your surgeon’s instructions carefully to ensure speedy healing and a good outcome.

It is normal to experience pain, swelling, and bruising after surgery. You will be given pain medications to manage the pain.

You will receive postoperative instructions to help reduce the risk of complications during the recovery period. Make sure to follow those instructions to the letter. If there are any doubts, ask your surgeon or the practice staff for clarification.

After a panniculectomy you will take sponge baths until cleared for a regular bath or shower. There will be restrictions on physical activity, including exercise and lifting heavy objects. You will be told to avoid pressure on the abdomen, which will mean sleeping on your back during the recovery period.

You may be fitted with support garments to wear while recovering. You should wear them all the time, except when taking a bath. Instructions will also be given or arrangements made to empty the drains and change the dressings.

Possible risks and complications

As with any surgical procedure there are risks involved in a panniculectomy procedure. You should be fully aware of potential risks and complications involved in any surgical procedure before you elect to go through with it. It is always better to err on the side of caution.

Specific complications that may occur during or after a panniculectomy include:

• Fluid collection (seroma)
• Blood clots
• Excessive scarring

If any of these occur, notify your surgeon immediately.

Just as you would discuss potential benefits before surgery, it is always advisable to ask your surgeon to address the potential risks as they apply to you. The surgeon can also advise you on how to avoid or minimise some types of risk.

Rough costs involved

The cost of a panniculectomy will vary depending on the surgeon you choose, the facilities used and the exact procedure performed. Your surgeon will help you estimate potential costs after an initial consultation.

Expect the surgery to cost somewhere in the range of $8,000 and $10,000 (AUD) including the surgeon’s and assistant surgeon’s fees, anaesthetist’s fee, hospital facilities and services and the cost of follow up visits.

Some private funds cover medically necessary panniculectomy. It is considered medically necessary when the redundant skin causes a functional impairment. In the absence of any such impairment, panniculectomy is considered cosmetic, and insurance may not cover costs of the procedure. Your private insurance fund may have other conditions, such as panniculectomy not being covered when it is performed as an adjunct to other medically necessary procedures such as hysterectomy, ventral or incisional hernia repair, unless the panniculectomy is also considered medically necessary.

Some Australian private health insurers may help pay for the hospital bed and theatre fees even if the procedure is not covered.

This information is correct as of 2019.