Panniculectomy Surgery


Valerie DeBenedette, Senior Medical Editor

Valerie DeBenedette is a science writer who specializes in keeping people informed about medicine and their health. She has more than 20 years of experience writing for newspapers, magazines, and websites and has written about most areas of medicine. For many years, she was a contributing writer to Cosmetic Dermatology and to Drug Topics, the leading pharmacy trade magazine. She also was a contributing editor to The Physician and Sportsmedicine for many years. She has written about most fields of medicine, including dermatology, sportsmedicine, ophthalmology, general surgery, orthopedics, and women's health; as well as public health policy and the pharmaceutical industry. In addition, she is the author of Caffeine, a book for young people. She is a member of the National Association of Science Writers.

May 19 2008

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There are several variations on the surgery that is usually called a tummy tuck or abdominoplasty. However, one type—the panniculectomy—is becoming more common because of the growing popularity of bariatric (or weight-loss) surgery.  A tummy tuck removes loose and excess skin on the abdomen and tightens up the vertical abdominal muscles (the rectus abdominis muscles)  which may have stretched apart due to pregnancy, weight gain, or simply age. While a panniculectomy can be used to remove a great deal of loose skin and fat in some cases, it does not repair any problems with the abdominal muscles.

"Whenever you are addressing the abdominal region, you have to deal with two components, the muscles and the skin and tissues. Each is treated separately," said Mark H. Schwartz, MD, FACS. Dr. Schwartz is a board-certified plastic surgeon with a practice in Manhattan and is Clinical Assistant Professor at the Weill Medical College of Cornell University in Manhattan.

A sagging abdomen, AKA a pot belly, may consist of excess skin and some fat or excess skin and fat and abdominal muscles that have separated and stretched out. In an abdominoplasty, or full tummy tuck, the surgeon corrects this stretching out, called diastasis, by pulling the muscles into their proper alignment and suturing them together.

If the abdominal muscles are in good shape, other procedures may suffice.  "In terms of improvement there is a spectrum of things to do," Dr. Schwartz said. Someone who just has a bit of a pot belly—a couple of pounds of fat that have resisted diet and exercise—can opt for abdominal liposuction, if they have good skin tone and elasticity and no excess skin, he said. Their skin will shrink to fit the new abdominal silhouette.

Who Is a Good Candidate for a Panniculectomy?

People with excess skin and fat that hangs a bit (or a lot) are good candidates for a panniculectomy, which gets it name because the medical term for a hanging belly is pannus. Many severely overweight people have a hanging belly and many who have lost a great deal of weight may be left with an apron of loose skin that hangs down past the hips and almost down to the knees, Dr. Schwartz noted. Skin, fat, and tissue that hang and overlap can cause medical problems, such as rashes and infections in the folds of skin and, in severe cases, backaches and difficulties in moving and hygiene.

The end of the spectrum, Dr. Schwartz described, is an abdominoplasty, which includes repair of the rectus abdominis muscles. In either a panniculectomy or an abdominoplasty, the belly button may need to be adjusted in a procedure called umbilicoplasty. "The belly button actually stays where it is and everything else is moved," he said. The skin is detached from around the belly button and is then pulled down and the excess is removed. A hole is made in the repositioned skin that is sewn around the belly button, he explained.

The Scar After a Panniculectomy

The big trade off between an abdominal liposuction, a panniculectomy, and a tummy tuck is the scar, Dr. Schwartz said. While a liposuction will create only small scars, a panniculectomy and a tummy tuck create a large scar that usually goes right across the abdomen from hip to hip. "A lot of times people talk about minimal invasive abdominoplasty, but the reality is that those provide minimal results," he said.

Both panniculectomy and tummy tuck have a recovery time of a few weeks, he added. A panniculectomy patient needs to block off 2 to 3 weeks and sometimes more where they can be away from work, he noted.

Often, a panniculectomy is performed as an adjunct to other abdominal surgery, such as hernia repair or hysterectomy, because the excess skin and other tissue are in the way. Dr. Schwartz noted that he is called in by a general surgeon or gynecologic surgeon several times a month to perform a panniculectomy in these circumstances.

Because an overhanging belly can be a medical issue, health insurance will pay for a panniculectomy in some circumstances.