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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. This is a more extensive form of a tummy tuck.

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

Indianapolis, Indiana

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