Panniculectomy Abdominoplasty Procedure Overview

There are several surgical variations on the surgery that is usually called a tummy tuck or abdominoplasty. The different names can be confusing because, in some circles, they are often all lumped together as a tummy tuck, while in others they are called by names that make them sound like completely different types of surgery.

One type—panniculectomy—is becoming more popular because of the growing use of bariatric (or weight-loss) surgery. Panniculectomy gets it name from pannus, the medical term for a hanging belly. A regular tummy tuck removes loose and excess skin on the abdomen and tightens up the rectus abdominis muscles, which may have stretched apart due to pregnancy, weight gain, or simply because of age. The plastic surgeon corrects this stretching out, called diastasis, by pulling the muscles into their proper places and suturing them together along the midline of your abdomen.

Like a tummy tuck, a panniculectomy also removes a great deal of loose skin and fat, and in some cases, a great quantity of skin and fat is removed. However, this surgery does not repair any problems with the abdominal muscles.

Panniculectomy is one of a spectrum of tummy tuck surgeries running from abdominal liposuction to a full tummy tuck with muscle repair. If you have just a bit of a pot belly—a couple of pounds of fat you can't diet away—and good skin tone, you will probably do well with abdominal liposuction. If you have a potbelly because your abdominal muscles have stretched apart from where they should meet, you can opt for abdominoplasty with muscle repair. If you have excess skin and fat that hangs, you could be a candidate for a panniculectomy.

Many severely overweight people have a hanging belly and many people who have lost a great deal of weight may have a flap of loose skin that hangs down. 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, even backaches, difficulty in walking, and problems with hygiene.

Often, a panniculectomy is performed as an adjunct to other abdominal surgery, such as bowel resection, appendectomy, or abdominal hysterectomy. The excess skin and fat of the belly may be in the way of the surgeon and has to be removed as a first step in the other surgery.

A panniculectomy will leave a very long incision scar across the belly, usually at about the level of the pubic hair. The surgeon may also leave surgical drains in place to keep fluids from building up behind the incision. A surgical drain is a plastic tube leading out of the body to a small bulb that collects fluid. These are removed a few days or a week or so after the surgery, depending on the amount of drainage.

A panniculectomy can be part of a circumferential body lift, where the incision is continued around the body and loose skin on the hips and buttocks is removed.

There may be some panniculectomies that are done on an out-patient basis, where you go home the same day, but most require at least an overnight stay in the hospital and even two or three days. For panniculectomies associated with other abdominal surgery, the length of the hospital stay may be dictated by the requirements of the primary surgery.

Because an overhanging belly can be a medical issue, health insurance may pay for a panniculectomy in some circumstances. You have to check with your health insurance company about this before you go ahead with surgery. If your health insurer says no, you can try filing an appeal.

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