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Dr. Barry Eppley

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Archive for the ‘abdominoplasty’ Category

The Occurrence of Seromas in Tummy Tuck Surgery

Monday, March 30th, 2015


Tummy Tuck results front view Dr Barry Eppley IndianapolisA tummy tuck is one of the most commonly performed aesthetic body contouring procedures performed. In many ways it is a ‘big’ operation when one looks at the size of the tissue segment removed and the amount of abdominal surface area manipulated. Despite the magnitude of the surgery, most patients heal remarkably well and suffer no major complications.

Tummy tucks do, however, have numerous minor early postoperative issues or complications. I hesitate to call them ‘complications’ as these minor wound healing issues rarely necessitate a return to the operating room for correction. The single greatest complication in tummy tuck surgery is that of seroma. This fluid collection which usually appears within weeks of the surgery can develop in ‘drainless’ tummy tucks as well as those that even use a drain.

In the April 2014 issue of the journal Plastic and Reconstructive Surgery, a paper was published entitled ‘Natural Evolution of Seroma in Abdominoplasty’. In this clinical study the aim was to evaluate when seromas after tummy tucks occur and how they progress. Using twenty one (21) female tummy tuck patients, abdominal ultrasound was performed in five abdominal wall regions at five different time points after surgery at four, eleven, eighteen, twenty-five and thirty-two days. Their findings shows that the incidence of seroma was roughy 5% percent on postoperative day 4, 38% percent on day 11, 33% percent on day 18, 24% percent on day 25, and 19 % on day 32. The left iliac fossa region had the highest volume of fluid collection on postoperative day 4, as did both the right iliac fossa and left iliac fossa regions on postoperative day 11. At other time points, the relative volume of fluid collection was significantly higher in the right iliac fossa region.

Large Tuck results side view Dr Barry Eppley IndianapolisWhile very annoying to patients, seromas are usually self solving problems aided by the use needle aspiration (tapping) in the office under local anesthesia. Rarely does a drain need to be inserted (or reinserted) to help solve it. What I always tell the tummy tuck patient that has developed a problematic seroma (which usually becomes evident 10 to 21 days after surgery) is that it will require tapping once a week for about a month before the fluid collection is solved. This study shows that seromas become most evident around two weeks after surgery and are still evident even at a month after surgery…supporting that these fluid collections are not quick to stop accumulating.

The location of the seromas is not always in the midline as one would suspect since this is the ‘bottom of the well’ so to speak. They often develop/persist more to the sides near the hips which is why they can be sometimes problematic to aspirate and why it is helpful to turn the patient on one side or the other to successfully tap them.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Long Terms Effects of Tummy Tuck Surgery

Monday, March 16th, 2015


Tummy Tuck abdominal reshaping Dr Barry Eppley IndianapolisBackground: Tummy tuck surgery can be an incredibly effective body contouring procedure. It achieves its effects through the removal of a large segment of loose skin and fat often combined with liposuction fat removal in areas beyond the zone of the cut out tissue segment. The benefits of tummy tucks can easily be seen in numerous plastic surgeon’s before and after photos.

But an interesting tummy tuck question is how long does the result last? Do the impressive early results persist and, if so, for how long?

Recent studies have shown that tummy tuck surgery may lead to significant and persistent weight loss for many women, particularly those who were overweight before surgery. (February 2013 issue of the journal Plastic and Reconstructive Surgery) It is postulated that this weight loss is due to a feeling of greater satiety after eating or other neuroendocrine mechanisms that may promote weight loss after surgery. It may be that the large loss of fat cells from the excised tissue segment may cause a lowering of certain hormonal levels that affect appetite. This is a plausible but unproven theory.

Case Study: This 38 year-old female wanted to get rid of her stomach rolls and reshape her waistline. She was not at an ideal weight but needed something to get her going in a positive direction and  decided that surgery would be a good impetus for it.

Long term Tummy Tuck result front view Dr Barry Eppley IndianapolisUnder general anesthesia, a full tummy tuck was performed along with liposuction of her flanks. She recovered well and after six weeks recovery and a few follow-up appointments was not seen again…until ten years later when she returned for breast reshaping surgery.

Long Term Tummy Tuck result oblique view Dr Barry Eppley IndianapolisLong Term Tummy Tuck result side view Dr Barry Eppley IndianapolisHer long-term tummy tuck results showed an overall body that was thinner and much more shapely than before surgery. It was clear she had continued to lose weight and get in better shape beyond what the initial tummy tuck surgery had achieved. This may have ben the result of a neuroendocrine effect but the psychological effects of increased patient motivation can not be denied as a contributing cause as well.

Case Highlights:

1) Tummy tuck surgery can dramatically change the shape of one’s stomach and waistline through a combined excisional and fat extraction approach.

2) Many tummy tucks will have a sustained and long-term effect through the removal of loose skin and fat cells in the excisional segment.

3) Some tummy tuck patients will go on to even improve their tummy tuck results through additional weight loss and body toning efforts.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Extended Tummy Tuck for the Double Roll Abdominal Deformity

Friday, February 13th, 2015


Background: Tummy tuck surgery is one of the most popular of all body contouring surgeries. While it usually results in a hip to hip scar in a traditional tummy tuck surgery, most women consider this a very acceptable trade-off for the abdominal flattening result obtained. While the abdominal scar can have its own aesthetic issues such as placement, shape and width, scar revision can often make improvements if needed.

What many people do not realize is there are many different variations of tummy tuck surgery. It is often seen as an operation consisting of only a full and mini- tummy tuck choice. But that is a simplistic approach to an operation that has up to eight (8) different tummy tuck types. The choice of tummy tuck is determined by how much abdominal skin and fat need to be removed and haw far around into the back the excision need to be done.

The ‘double roll’ abdominal deformity consist of two distinct abdominal skin and fat rolls. The larger roll is at the lower abdominal area between the belly button and the pubic and creates varying degrees of waistline overhang. The smaller second roll lies above the belly button and creates a smaller overhang that partially obscures the belly button. The double roll abdominal deformity almost always result from moderate weight loss, although not necessarily from bariatric surgery

Case Study: This 42 year-old female wanted to improve her abdominal shape after multiple pregnancies and a 40 lb weight loss. She had lost about the most weight that she could and had hit the ‘wall’ when it came to making any further abdominal reduction/reshaping on her own.

Extended Tummy Tuck result frnt view Dr Barry Eppley IndianapolisExtendedTummy Tuck results side view Dr Barry Eppley IndianapolisUnder general anesthesia, a large horizontal ellipse of skin and fat was marked out which went above the belly button. It was removed in a full thickness fashion down to the abdominal wall. The central part of the upper abdominal flap was undermined so that midline rectus fascial plication could be done. The upper abdominal skin flap was brought down to close to the lower pubic side of the excision. To adequately work out the large ‘dog ears’ that resulted at the ends of the incisional closure, further ellipses of skin and fat resulted in the abdominal closure extending around the hips creasting a near 300 degree wrap around the waistline.

Extdnded Tummy Tuck results oblique view Dr Barry Eppley IndianapolisSuch extended tummy tucks are needed when there is more than one abdominal roll. Single abdominal rolls can be removed and the length of the scar kept to just around the hip area. But when the vertical ellipse of abdominal skin is more extensive as occurs in double rolls, the eventual length of the tummy tuck scar will find its ways into the back.

Case Highlights:

1) The double roll abdominal deformity requires an extended tummy tuck to adequately remove the loose abdominal skin and fat and create a near flat abdomen.

2) The extended tummy tuck creates a long incision and resultant scar that goes beyond the hips onto the back.

3) The recovery from an extended tummy tuck is no longer than that from a traditional shorter scar tummy tuck.

Dr. Barry Eppley

Indianapolis, Indiana

Lovenox for DVT Prevention in Tummy Tuck Surgery

Sunday, January 25th, 2015


Tummy Tuckj Surgery Indianapolis Dr Barry EppleyDeep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) is the most dreaded complication of tummy tuck surgery. For that matter it is an increased risk for any aesthetic surgery around the abdomen/pelvic regions that involves compression (binder/garments) and any period of immobility after the procedure.While it is rare, it can occur and is a postoperative problem that has gotten a lot of attention recently.

There are a variety of before and after surgery considerations that can increase the risk of developing a DVT and/or PE. Genetics/family history, current medications (e.g. birth control pills), lack of movement after surgery and fluid levels (dehydration) can all contribute to an increased tendency for blood flow to slow down and have an increased tendency to clot.

Of all aesthetic plastic surgery procedures, the tummy tuck is at the highest risk for DVT/PE. The binding of the abdomen, the discomfort of muscle plication,the increased pressure on the vena cava and the subsequent tendency for limited early mobility after surgery are a potential setup for slowed venous blood flow return from the legs. If you factor in other adjunctive procedures like liposuction of the thighs and hips, and the subsequent circumferential binding used, the risks are further increased.

Lovenox Injections Indianapolis Dr Barry EppleyThe most common DVT preventative medication used for tummy tuck surgery and other high risk patients is Lovenox. Known generically as Enoxaparin, Lovenox is a low molecular weight heparin that is given by subcutaneoous injection. It works by binding to and increasing the activity of antithrombin III. By so doing it inhibits coagulation factor Xa. Since factor Xa assists in the conversion of prothrombin to thrombin, decreased thrombin levels prevent the formation of fibrin clots.

There is certainly a debate whether every tummy tuck patient should get Lovenox or just those that are at the highest risk. That is an individual plastic surgeon’s decision. The prophylactic dose of Lovenox is 30 mg subcutaneous injection twice daily with the initial dose administered within two or three hours of surgery and continuing for one week thereafter. There is no specific dose for weight-based Lovenox for use as DVT prophylaxis but most surgeons do not exceed 0.5 mg/kg every 12 hours.

Lovenox is historically expensive but generic versions (enoxaparin) have become available which dramatically lowers the cost. Insurance often covers its use but for an aesthetic surgery it may not be covered.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Case Study: The Vertical Tummy Tuck

Friday, January 23rd, 2015


Background: The vast majority of tummy tucks can and are performed through a curved horizontal lower abdominal incision. (as well as around the umbilicus) There are, however, alternatives to this traditional excisional orientation in the right patient. A handful of patients may benefit from a vertical excisional approach.

When a vertical tummy tuck is typically thought of it is part of the ‘fleur-de-lis’ type. This is a tummy tuck where a vertical excision is combined with a horizontal one because there is too much side-to-side skin excess in the upper abdomen that cannot be addressed by a standard tummy tuck. This type of tummy tuck is almost exclusively used in massive weight loss patients.

Besides the fleur-de-lis pattern, there are other variations in which the vertical tummy tuck is completely vertical with no horizontal component.

Case Study: This 65 year-old female wanted to improve the shape of her stomach but did not want to commit to a traditional full tummy tuck. She asked if there was anything else that could be done. Her loose abdominal skin did not bode well for liposuction alone. But with her existing vertical scar from prior abdominal surgery decades ago, the concept of liposuction combined with some limited tissue removal became possible. This would allow liposuction to be performed and also deal with the skin laxity problem that would ensue.

Vertical Tummy Tuck results front view Dr Barry Eppley IndianapolisVertical Tummy Tuck result side view Dr Barry Eppley IndianapolisUnder general anesthesia, power-assisted liposuction was performed on her whole abdomen as well as out onto her flanks. Over 700ccs of fat aspirate was obtained. Then a vertically oriented ellipse of skin and fat was removed from the belly button down to the pubis incorporating her existing indented scar. Muscle plication was not deemed necessary at her age and desire for a short recovery. No drain was used.

Vertical Tummy Tuck result left side view Dr Barry Eppley IndianapolisHer recovery was uneventful with full return to all activities by three weeks after surgery. While she was still left with a vertical scar, which is how she started, the scar was no longer indented and smoother with the surrounding now flatter abdominal skin surfaces.

The vast majority of tummy tucks can be performed safely and effectively through a curved horizontal lower abdominal incision (and an incision around the umbilicus). However, there is a limited subset of patients for who may benefit from a vertical incision. This is certainly the case in someone who has an existing vertical incision.

Case Highlights:

1) Excessive skin and fat on the abdomen is not  a one-dimensional tissue problem.

2) A vertical tummy tuck removes skin and fat down the midline of the abdomen, most typically from the umbilicus down to the top of the pubis. (a mini tummy tuck)

3) A vertical tummy tuck works best in women who have an abdominal shape that is longer than it is wide.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Case Study- Tummy Tuck in Asian Female

Wednesday, December 24th, 2014


Background: Tummy tucks are uniformly successful at reshaping the abdominal wall through the removal of excess skin and fat. While the amount of abdominal wall tightening is one criteria by which tummy tucks are judged, they are equally critiqued by the scars that are needed to create it. The fear of most tummy tuck patients is the long horizontal scar and whether it will be an acceptable trade-off for the abdominal tissue removal.

The appearance of a tummy tuck scar is influenced by many factors, particularly the skin type on which it is performed. The more pigment that is naturally in the skin, the more likely the scar after surgery will be noticeable. Ironically this is less of a concern in the darkest skin pigments. (e.g., African Americans) Intermediate skin pigments, like in Asians and Hispanics for example, have a tendency to over react with pigmentation as it has been injured and heals. The development of hyperpigmentation can make scars very noticeable and it rarely subsides with time unless treated early.

Case Study: This 37 year-old Asian female male wanted to improve the shape of her abdomen and waistline which had been significantly changed by multiple pregnancies and weight gain.

HH Tummy Tuck results front viewUnder general anesthesia, a full tummy tuck was performed with belly button recreation through stalk shortening and the making of a new skin opening. Power-assisted liposuction was done around the waistline into the flank areas as well as the sides of abdomen above the tummy tuck incision.

HH Tummy Tuck results oblique viewHH Tummy Tuck results side viewRecovery from a full tummy tuck with flank liposuction really takes about three full weeks until one can comfortably do most normal activities. (not working out yet) It takes another few weeks until exercise and more strenuous activities can be resumed.  (four to six weeks) It took her a full two months until she was completely back to normal and every last millimeter of her incisions were fully healed…which is exactly normal for full tummy tucks.  At six months after surgery, her scars showed no significant hyperpigmentation reaction.

The development of areas of darker skin next to scars after surgery is known is known as post-inflammatory hyper pigmentation (PIH). A variety of ways to prevent/treat these type of skin scars including topical scar gels/tapes. Some of these topical treatments do contain agents to quell a hyperpigmentation response. While none of these scar treatments have ever been proven to be superior to another, their uses are not associated with causing any other problems either. When topical scar treatments are indicated, I find the use of 3M Micropore skin tape to be both simple and effective. Taping the scar for months after surgery is very useful. Should hyperpigmentation develop, topical bleaching agents can be applied with the tapes.

Case Highlights:

1) Tummy tuck surgery can be done in any woman of any ethnicity with equally successful results.

2) Women with intermediate pigmented skin are at risk for more visible tummy tuck scars due to a hyperpigmentation response.

3) Postoperative scar taping and use of bleaching agents can be useful treatments to prevent or treat tummy tuck scar hyperpigmentation in ethnic patients.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Case Study: Combined Tummy Tuck and Brazilian Butt Lift

Monday, November 24th, 2014


Background: Two of the most popular body contouring procedures today is one from the past and a relatively new one. Tummy tuck surgery has been around for over five decades and is highly successful at reshaping the abdominal wall often in a dramatic fashion. Conversely, buttock augmentation by fat injections (aka Brazilian Butt Lift) has been available now for only a decade and is the fastest growing body contouring procedure in total number done being done compared to just five years ago.

Brazilian Butt Lift Reshaping Garment Dr Barry EppleyWhile a tummy tuck works by removing and discarding unwanted tissues, a Brazilian Butt Lift works by recycling/redistributing them. Fat removal by liposuction is part of many tummy tucks to help extend its contouring effects around the waistline and is an additive ‘bonus’ to the procedure. Conversely, fat harvest by liposuction is an essential part of a Brazilian Butt Lift and the more fat that can be harvested the better the buttock augmentation result will be.

It is not uncommon that the desire for abdominal reshaping and buttock augmentation exist in the same patient. The first question is whether a tummy tuck and buttock augmentation can be safely done at the same time. Depending upon the magnitude of the liposuction harvest and the extent of the tummy tuck, the answer would be yes if neither one was particularly extensive.

The other question is whether any part of the excised portion of the tummy tuck can be used for the buttock augmentation. This is a debate between aggressively harvesting fat from under the tummy tuck prior to its excision or using the tummy tuck discard as a dermal-fat graft ‘autoimplant’ in the buttocks.  The vast majority of plastic surgeons today would use liposuction to harvest fat at the same time as the tummy tuck. There are growing numbers of reports in which the tummy tuck segment is being recycled and used like a buttock implant.

Case Study: This 30 year-old female wanted to have a tummy tuck to reshape her abdominal waistline as well as a buttock augmentation at the same time. It was agreed that she did not really have an optimal amount of fat to harvest to achieve a substantially larger buttocks. But she wanted to take any fat that could be harvested and place it into the buttocks as a ‘bonus’ to the procedure.

Tummy Tuck and Brazilian Butt Lift result front view Dr Barry Eppley IndianapolisUnder general anesthesia, liposuction was initally done very aggressively under the tummy tuck portion which was to be removed. Liposuction was also done around the waistline and into the flank areas to harvest as much fat as possible. The tummy tuck procedure was then completed. The harvested fat was processed and concentrated, obtaining a total volume of 480cc. Each buttock was injected with 240cc in a cross tunneling fashion.

Tummy Tuck and Brazilian Butt Lift result back view Dr Barry Eppley IndianapolisTummy Tuck and Brazilian Butt Lift result side view Dr Barry Eppley IndianapolisHer recovery was typical for a tummy tuck and the buttock augmentation do not prolong it. At three months afterwards, she showed marked improvement in her abdominal contour and mild enhancement of her buttock size. While the increase in her buttock size was not substantial (nor was it expected), its effect was greater due to reshaping of the waistline above both buttocks.

Some buttock augmentation procedures are done as a ‘bonus’ to other body contouring efforts. While the amount of fat that is often obtained by liposuction may be inadequate to justify a ‘stand alone’ Brazilian Butt Lift, some patients may want the fat used for the buttocks with the attitude that it can not hurt and anything they get is more than they currently have.

Case Highlights:

1) Combining a tummy tuck with a Brazilian Butt Lift is not uncommon and can safely be performed together.

2) The planned excisional portion of the tummy tuck can be aggressively liposuctioned as  part of the donor fat for the Brazilian Butt Lift.

3) Like all Brazilian Butt Lifts, the result is a combination of how much fat can be harvested and how much fat survives.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Tummy Tuck for the Clefted Abdominal Pannus in a Hispanic Female

Wednesday, October 8th, 2014


Background: A tummy tuck is one of the most common and successful body contouring procedures. Between pregnancies and weight loss, the development of loose skin and fat on the abdominal wall is inevitable for many women. This usually appears as a loose overhang on the lower abdomen that hangs like a hammock depending upon its size. This overhang has become known as an abdominal pannus which signifies an apron-like deformity.
One of the unique types of abdominal pannuses has a somewhat familiar look. Any surgery previously done that leaves a vertical scar between the belly button and the pubis (e.g., old style c-section) creates a split down the middle of the pannus. Because a surgical scar often has little fat underneath it, and may even be stuck to the underlying fascia, this results in an indentation which results in a pannus divided into two halves. Patients often refer to this as having a ‘buttocks’ on their front side. The bigger the abdominal pannus is the more likely it appears like a pair of buttocks.
A tummy tuck always creates a low horizontal scar of variable lengths. That is the inevitable trade-off for getting rid of the abdominal pannus. Certain ethnic groups are at higher risk for adverse scar formation, most commonly hyperpigmentation. Intermediate skin pigments, such as Hispanics and Asians, are at such risk as their skin types have well known reactivity to incisions particularly those placed under tension.
Case Study: This 38 year-old Hispanic female wanted a tummy tuck. She had a prior c-section done in Mexico for the delivery of her two children. Between the two pregnancies and some small weight gain, she had developed a ‘butt’ appearance on her lower abdomen with the scar acting as a tether between the two halfs.
Hispanic Tummy Tuck result front viewUnder general anesthesia she had a full tummy tuck done. The large horizontal cut out was done from just above the belly button down to the pubis. Her lower abdominal pannus with its buttocks appearance was completely removed and replaced with a low horizontal scar. Liposuction was done on the flanks on both sides.
Hispanic Tummy Tuck result oblique viewHispanic Tummy Tuck result side viewHer tummy tuck scar developed a small amount of hyperpigmentation but no significant hypertrophy. Over the course of the next year some scar lightening occurred but complete fading to normal color did not occur. This is a common risk in the hispanic tummy tuck patient.
Case Highlights:
1) The clefted abdominal pannus (frontal butt appearance) is caused by a vertical scar between the belly button and the pubis.
2) A full or complete tummy tuck removes the entire deformed abdominal tissue to create a smooth and flat lower abdominal wall.
3) Tummy tuck surgery in Hispanics has a high propensity for hyperpigmented scarring which may require a secondary scar revision.
Dr. Barry Eppley
Indianapolis, Indiana

Tummy Tucks May Improve Urinary Incontinence

Saturday, September 27th, 2014


One of the most common body contouring operations after pregnancies and significant weight loss is the abdominoplasty or tummy tuck. The known benefits of tummy tucks lie in the change they bring to the shape of the abdomen and waistline. If the abdominal tissue cut out is big enough, patients may also see improvement in back pain and skin hygiene in the groin creases. One of the other potential benefits for some patients that has been reported in several small studies is an improvement in urinary incontinence.

Urinary Incontinence IndianapolisIn the September issue of the Aesthetic Surgery Journal a study was published entitled ‘Improvement in Stress Urinary Incontinence after Abdominoplasty’. In this paper 250 women who underwent tummy tuck surgery were evaluated after surgery for urinary incontinence (UI) symptoms by survey. Only 100 patients (40%) completed the survey. Of these 100 patients, 60% reported an improvement in their UI symptoms while the other 40% did not. Lack of having had a prior c-section was the one factor identified that was a good predictor of improvement in UI symptoms after tummy tuck surgery.

Urinary Incontinence and Tummy Tuck Surgery Dr Barry Eppley InianapolisHow a tummy tuck may improve UI is speculative but it could be surmised that the relief of the pressure of excess abdominal tissue pressing down on the bladder is a contributing factor.  It could also be that elevation of the pubic mound as result of the tummy tuck affects the urethral sphincter favorably. There is very scant discussion in the medical literature about any correlation between UI and abdominal contouring surgery so the exact mechanism of how the improvement occurs is not yet known.

This study, while not proving a decisive link between abdominoplasty and UI improvement, is strongly suggestive. A 60% stated improvement by patients indicates that it is more than just an infrequent occurrence. Since not all patients who had UI symptoms before surgery got improvement, it would be important to figure out whom is most likely to do so. This would be beneficial for UI patients who may avoid the need for other treatments if a tummy tuck is done first.

Dr. Barry Eppley

Indianapolis, Indiana

Healing and Wound Complications in Supersize Abdominal Panniculectomy Surgery

Wednesday, September 17th, 2014


The abdominal pannus is a stomach deformity where any amount of tissue hangs over the waistline. The term, pannus, is derived from a latin word for apron so it is fitting that any overhang is referred to as such. In days before bariatric surgery, abdominal panniculectomy surgery was very common and it was almost always associated with morbid obesity. Because of bariatric surgery, the most common abdominal panniculectomy today is much smaller and is done after large amounts of weight loss. These pannuses are largely skin and the overall health of the patient is generally good since they are more weight appropriate for their height.

Abdominal Panniculectomy Indianapolis Dr Barry EppleyBut despite the popularity and widespread availability of bariatric surgery, not every obese patient undergoes it or is eligible to do so. This still leaves certain patients who are overweight that suffer from a large pannus with all of its associated symptoms. There has been some understandable reluctance to operate on such overweight patients due to the increased risk of complications that is known to occur .

In the October 2014 issue of the Annals of Plastic Surgery, an article was published entitled “Supersize” Abdominal Panniculectomy: Indications, Technique, and Results’. In this paper, the authors reviewed a series of 26 patients over a six year period that had abdominal panniculectomies performed that weighed over 10 kgs. (22 lbs), hence the term supersized pannus. The indications for surgery were typical including a large amount of overhanging abdominal skin and fat (hangs down to mid-thigh level) that was associated with underlying chronic skin infections, history of panniculitis, and the presence of a hernia. Of the 26 patients, the mean pannus weight removed was over 15 kgs with a followup period of over a year. The overall wound complication rate for the “supersize” panniculectomy over 40%. (11/26 patients). The rate of major complications, defined as those complications requiring a return to the operating room, was just over 10%. (3/26 patients).

Abdominal Pannus Removal Indianapolis Dr Barry EppleyThe relevance of this paper is that it demonstrates that larger abdominal panniculectomies can be done and offer a dramatic improvement in mobility and function of the patient. However, it creates a large abdominal incision and has a lot of ‘dead space’ inside to heal. As a result, wound complications are common (and to be largely expected) and  revisits to the operating room for their management are not rare. This type of abdominal surgery should be confused in this regard with the more common tummy tuck. A CT scan done before surgery can help discover a hernia which can be very difficult if not impossible to pick up on a physical examination of a large pannus.

This paper of larger abdominal panniculectomies supports what I tell my patients…the operation will be highly successful and can be life-changing but there is a very high incidence of wound complications and the need for further surgery/hospitalization is not rare. In the long run it will be very much worth it but expect a healing period of two to three months for a full recovery.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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