Explore Plastic Surgery - Dr. Barry Eppley

The abdominal panniculectomy is a variation to the traditional tummy tuck or abdominoplasty.  The pannus  or abdominal apron is that overhang of skin and fat that extends below one’s waistline. Abdominal pannuses can exist in overweight as well as extreme weight loss patients after bariatric surgery.

The abdominal panniculectomy, historically, refers to the pre-bariatric surgery era when extremely overweight patients had large skin and fat overhangs. Heavy pannuses were surgically removed to relieve the medical symptoms that they caused such as skin irritations and rashes from the moisture and heat that builds up underneath it. With an obese patient, panniculectomies were associated with high wound complication rates due to the size and depth of the cut outs. Such surgical removals of abdominal  overhangs today await weight loss through bariatric surgery first, leaving a smaller pannus on a thinner person.

The abdominal panniculectomy is different than a true tummy tuck in that the skin edges are not as undermined, no muscles are tightened, and no areas are treated by liposuction.  It is simply an amputation of whatever overhangs the waistline. In the obese patient, this pannus may have considerable weight anywhere from 30 lbs or higher. In today’s bariatric patient, the pannus may weigh only from 5lbs. to 10 lbs due to the prior weight loss.

Because of the relief of medical symptoms, the abdominal panniculectomy may be covered by insurance. Since the panniculectomy procedure in the bariatric surgery patient today weighs considerably less and often only involves improvement of an undesired contour, it is often called cosmetic by one’s health insurance. To be considered medically eligible for insurance coverage, there has to be very specific criteria that are met and a documented trail of medical records that substantiate symptoms related to the pannus. Most importantly, photographs must demonstrate that the pannus hangs onto or below the groin creases.

Abdominal panniculectomies remove large surface areas of skin and fat. Because of the amount of excess tissue present, removal may need to extend way into the back and include a vertical cutout as well as that in the horizontal dimension. This does leave long scars but patients with these skin excess problems always feel that it is a good trade-off. The biggest complications from these procedures is a seroma or build-up of fluids which is why drains are needed for several weeks after surgery.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Since the advent of bariatric surgery and the rise in the number of such procedures every year, a traditional body contouring plastic surgery procedure is undergoing a change. That procedure is the abdominal panniculectomy…or the cutting off of one’s overhanging pannus.

Panniculectomy surgery is a reconstructive procedure performed to remove a panniculus, sometimes referred to as a pannus or overhanging abdominal apron. The pannus frequently contributes to a number of health problems, including chronic wounds and skin infections due to the moisture underneath the skin folds. 

In the recent past, prior to weight loss from bariatric surgery, an abdominal pannus was quite large (as was the patient) and quite hefty in weight. Many of these pannuses would hang at least down to the middle of the thighs and often to the knees. I have seen a few that hung well below the knee and one that hung down and rested on the floor. My personal ‘record’ for an abdominal panniculectomy was a patient who weighted 715 pounds and a pannus that weighed 96 lbs. Removing these large pannuses required some clever intraoperative methods to hoost them up (known as the ‘china wall’) just to get underneath it to do the cutting. Because of the magnitude of the abdominal wall resection, wound complications after large abdominal panniculectomies were the norm with fluid build-ups and problems with healing of the incision.

While removal of a massive abdominal pannus solved a few health problems for the very obese patient, it did little for their general well-being or improve longevity. Along came bariatric surgery and we have seen a fortunate change in the large abdominal pannus patient. As bariatric surgery has helped patients lose a lot of weight, so has the size of abdominal pannuses decreased. Most abdominal pannuses that I see today are in the bariatric surgery patient or someone that has lost over 100m lbs. on their own. 

These sizes of abdominal pannuses are much more manageable, have fewer complications after their removal, and the patients are overall much healthier. The typical pannus that is removed today, often part of a circumferential lower body lift, weighs 10 lbs. or less. Such abdominal pannuses are a welcome sight from those large ones in the past. 

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis