Panniculectomy - Indications, Contraindications, Procedure, and Alternatives

Introduction

With the increasing incidence of obesity, there is also an increase in the weight loss procedures undertaken by individuals. Weight loss procedures can be of any type, such as changing the diet regimen, heavy exercising, or undergoing bariatric surgery (surgery to help a person lose weight). These weight loss procedures can lead to the hanging of the excess skin, especially in the lower abdomen region. This excess skin is removed by a surgery called a panniculectomy. It is a simple procedure but can lead to significant complications if not planned out properly.

What Is Panniculectomy?

‘ Pannus’ refers to the excess skin hanging below the abdomen, and ‘ectomy’ refers to the removal. The pannus can extend up to the thighs or even the knees interfering with the patient's comfort in daily activities. Hence, a panniculectomy removes this excess fat and makes the abdominal region flat.

What Are the Reasons for Developing Excessive Loose Skin?

Apart from the major weight loss procedures, the other causes of excessive loose skin include:

• Aged people.

• After pregnancy.

• Hereditary.

Who Are the Suitable Candidates for Panniculectomy?

Patients prefer panniculectomy for functional concerns or medical issues. The ideal candidates for the surgery include:

• The person must be healthy.

• Presence of irritating rashes or infections under the hanging skin folds.

• Non-smoker.

• Stable weight for the past six months to one year.

• Physically active.

When Is Panniculectomy Not Indicated?

The reasons that make a candidate unsuitable for panniculectomy surgery include the following:

• Active smokers are not the right candidates for surgery as smoking can affect the blood supply and wound healing.

• Patients with uncontrolled diabetes, heart disease, and lung disease.

• Excessively obese patients with a higher BMI (body mass index) value.

How to Prepare a Patient for Panniculectomy Surgery?

Before the surgery, the patient must undergo a few medical tests, and complete medical history is noted.

• The patient has to sign a consent form as a willingness to start the procedure.

• If the patient is an active smoker, the habit is quit immediately.

• If the patient is under any medication, such as a blood thinner (Aspirin), it is stopped for a few days with the physician’s consent.

• The doctor prescribes medications that the patient has to consume before the procedure.

• The patient has to maintain a stable weight for about six to eighteen months before the procedure.

• Any allergy to the medication or anesthesia is noted to prevent complications after the surgery.

How Is Panniculectomy Surgery Done?

It is usually done as an outpatient procedure or under an operation setup, depending on the patient’s condition. An experienced plastic surgeon performs the surgery.

• For painless surgery, the operation is done under general anesthesia.

• An incision or a cut is made on the abdomen from below the breast bone to the pelvic bone.

• Above the pubic area, a horizontal cut is made from one hip bone to the other.

• The size of the incision depends on the amount of skin to be cut by the surgery.

• The surgeon then cuts deep into the muscle and removes the excess skin and fat.

• The incision that is made is closed with sutures.

• A suction drain is placed before closing with sutures to drain out the accumulated excess fluid.

After the patient recovers from the anesthesia, they will be able to walk slowly. The patient is monitored for a day to observe any reactions to the surgery. The patient is discharged on the day of surgery or after a few days requiring a hospital stay to monitor the patient.

How Is the Recovery After Panniculectomy Surgery?

• The patient experiences pain and swelling after the surgery, which subsides by consuming the painkillers prescribed by the doctor.

• The doctor provides information regarding the care of the suction drain placed. The amount of fluid collected and the procedure to empty the fluid is explained to the patient.

• Heavy exercises causing strain to the body are avoided for about four to six weeks after the surgery.

• A compression binder (a belt worn around the abdomen to support the incision and relieve pain).

• The surgeon gives a date for the review of the operation site. The drain and the sutures are removed on this day.

• Regular visits to the doctor are followed to maintain the health of the patient post-surgery.

What Are the Risks Involved With Panniculectomy Surgery?

Any surgery on the body involves numerous risks and complications. It is up to the doctor and the patient to decide how to overcome these complications. The following are the risks involved in the surgery.

• Allergic reactions to anesthesia.

• Bleeding.

• Continuous pain.

• Fluid accumulation.

• Deep vein thrombosis (blood clots that are formed in the deep veins of the leg).

• Fat necrosis (death of the fat tissue deep inside the skin).

• Hematoma (pooling of blood due to injury to the blood vessel).

• Infection.

• Swelling of the skin due to any infection.

• Changes in the skin sensation, such as numbness.

• Delayed healing of the wound.

• The skin becomes loose again and starts to hang.

• Skin loss.

• Scarring of the operation site that is anesthetic.

What Are the Alternatives to Panniculectomy Surgery?

The surgeon decides on the type of surgery according to the patient’s condition. Apart from panniculectomy, alternative surgical options include:

1. Liposuction or Lipoplasty - It is a surgical procedure to remove excess body fat.

2. Abdominoplasty - Also called a ‘tummy tuck’ procedure. Both panniculectomy and abdominoplasty are done to remove the loose skin after weight loss. A tummy tuck procedure is done for cosmetic reasons, like after pregnancy, to treat minor loose skin issues. It also strengthens the muscles of the abdomen. On the other hand, a panniculectomy is done to treat loose skin causing medical illness and discomfort to the patient.

3. Lipectomy - A surgery to remove the loose skin from the thighs and arms. It does not cause skin tightening.

Panniculectomy is not the only option for treating loose skin. In fact, a panniculectomy is associated with more complications compared to abdominoplasty. The doctor is consulted to make a proper decision that suits well for the patient and is beneficial to their needs.

Conclusion

Panniculectomy is a common procedure performed after major weight loss to improve the functioning of the patient. The success of this procedure in enhancing the functional demand is good, but the complications arising post-surgery are high. If the patient needs to remove the excess fat for cosmetic reasons, then there are other alternatives available with minimal complications. Thus, the surgeon has to be well-planned while performing this surgery and ready to manage the complications appropriately for a healthy outcome.