Panniculectomy

Panniculectomy is a surgery to remove the pannus, which is the excess fat tissue and skin hanging down from the abdomen over the genitals or thighs. Pannus is formed after a massive weight loss (45 kg or more).

Your skin stretches slowly with time as you gain weight. However, as you lose weight, the stretched skin may not be able to shrink back into place. This may cause the skin to sag and hang. This extra skin hanging from your abdomen may cause difficulty in performing normal tasks, such as walking and cleaning yourself and lead to sores or rashes. It may also decrease your confidence.

A panniculectomy is either performed to resolve cosmetic concerns or medical problems. However, this procedure should not be considered as a replacement for exercise and proper diet.

Read more: Balanced diet chart

A surgeon may recommend panniculectomy if you have the following symptoms due to a pannus:

• Difficulty in walking and performing other physical activities
• Skin infections, rashes or sores, irritation or discomfort
• Inability to keep your genitals and thighs clean
• Hernia (a condition where tissue protrudes out through an opening in the abdominal muscle)
• Trouble urinating
• Poor self-confidence
• Difficulty in sexual activity

You are eligible for the surgery if you fulfil the following requirements:

• You have stable body weight for the last six months. If you have undergone bariatric surgery (a surgery that helps in losing weight by making changes to your digestive tract), you need to be at a stable weight for 18 months.
• You are physically healthy
• You are a non-smoker
• You have persistent or recurring infections under the pannus
• You do not respond to the treatment for rashes formed in the skin folds
• You have realistic expectations from the surgery

Your surgeon may not recommend this surgery if you:

• Are an active smoker
• Have uncontrolled lung disease or heart diseases
• Have diabetes

Have morbid obesity (body mass index > 40) and have undergone bariatric surgery.

You need to be prepared for the following before the surgery:

• Your doctor will take your detailed medical history. Inform him/her if you are taking any prescribed and non-prescribed medicines, herbs, supplements or vitamins.
• You will be asked to stop taking medicines that hinder the blood clotting process a few days before the surgery. These medicines include ibuprofen, aspirin or warfarin.
• Stop smoking before the surgery as it prolongs the healing period and increases the risk of complications.
• The surgeon will discuss with you the risks associated with the surgery.
• You will be asked to undergo the following medical tests before the surgery:
  • Blood tests: To check for anaemia, infection, and kidney function
  • Pulmonary function tests: To evaluate your lung function
  • Electrocardiogram: To evaluate your heart function Read more: What is an electrocardiogram
• You will need to arrange someone to take you home after surgery. You may also need to arrange someone to help you at home for one to two days after being discharged

Your doctor may ask you to not eat anything after midnight the night before the surgery. However, you may be allowed to drink clear liquids such as water or tea (without milk) until the morning of the day of surgery and to take your medicine, on the day of the surgery, with minimum water.

You will need to sign a consent form, which gives your approval for the surgery. 

The surgery will be performed under general anaesthesia to keep you unconscious and pain-free. In rare cases, spinal anaesthesia (a medicine that keeps you awake but pain-free during the surgery) is given.

The procedure usually involves the following steps:

• A surgeon will make a horizontal incision (cut) between your belly button and pubic hairline. The length and shape of the cut depend on the amount of excess skin that needs to be removed. For example, some times, the belly button needs to be removed altogether and if the loose skin is on sides, a vertical incision will be made instead.
• The surgeon will trim the excess skin and stitches the two sides together with the remaining skin pulled down from the upper abdomen. 
• Next, he/she will reposition your belly button and make a new opening for it in your abdomen.
• The surgeon will insert small tubes temporarily into your abdomen to drain out the fluids from the wound.
• Finally, he/she will cover your wounds with a dressing.

The entire procedure may require two to five hours for completion. When you regain consciousness after the surgery, the medical staff will ask you to take a short walk. You will notice the results right after the surgery. You will be hospitalised for at least two days after the surgery.

Antibiotics will be given to you during and after the surgery to prevent infections. To minimise swelling during the recovery period and to support your abdomen, you will be asked to wear an elastic bandage during the recovery period. 

You can expect the following during the recovery period after surgery:

• It may take up to two weeks for you to stand upright due to internal swelling after surgery. You may also experience pain, swelling, bruising, numbness and tiredness. The surgeon will prescribe medicine to relieve the pain.
• Your doctor will suggest you to keep your legs and hips bent while resting. This may provide relief by reducing pressure on your abdomen. 
• Avoid strenuous activities for about four to six weeks after the surgery to prevent any strain on the abdomen.
• You will be able to resume work about a month after surgery.
• The swelling and wound on the abdomen may take up to three months to heal.

Although you will be able to see improvements immediately after the surgery, it may take up to two years for you to see the final outcome of the surgery and for the scars to fade. Panniculectomy provides long-lasting results when coupled with a balanced diet and exercise. If the surgery does not meet your expectations, talk to your surgeon. Some people require additional surgery to achieve the desired results.

The surgery helps to: 

• Perform your regular daily activities
• Improve your appearance and health

When to see the doctor?

You should contact the surgeon immediately if you experience any of the following symptoms after surgery:

• Redness
• Fever
• Excessive drainage from the wound
• Shortness of breath
• Excessive bleeding
• Chest pain

The possible complications of panniculectomy include:

• Risks from anaesthesia such as breathing problems, blood clots or bleeding
• Infection
• Scarring
• Loose skin
• Poor wound healing
• Tissue death
• Nerve damage
• Skin loss
• A build-up of fluid under the skin

You may need to follow up with your doctor on a weekly basis for the first month after surgery. The doctor will schedule the required follow-up appointments thereafter.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.