A panniculectomy is a surgical procedure that aims to remove excess fat and overhanging skin from the abdomen. An abdominal panniculus is a medical term that describes a layer of fatty tissue that is present in the lower abdominal area.

Also known as body contouring surgery, a panniculectomy involves changing the shape and contour of the body by removing excess skin and fat that hangs from the abdomen. Many people may find fat below the bellybutton area, which they may refer to as a FUPA, to be the most difficult type of fat to lose. A person may require the procedure following significant weight loss, bariatric surgery, or pregnancy.

A large panniculus may affect a person’s life in several ways, potentially resulting in infections, rashes, and difficulty walking. If the area does not respond to dietary changes and exercise, a person may be a candidate for a panniculectomy.

In this article, we discuss the panniculectomy procedure, including what it involves, who may be a suitable candidate, and how it differs from a tummy tuck.

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Typically, the most common candidates for panniculectomies are people who have experienced dramatic weight loss. As a result of the sudden weight loss, the person may have excessive abdominal skin that may overhang the groin and pubic regions. Other reasons why a person may undergo a panniculectomy include:

  • pregnancy
  • previous surgery, such as bariatric surgery
  • age

Generally, the best candidates for a panniculectomy are individuals who are in relatively good health but have excess abdominal fat or skin that does not respond to diet and exercise. Additionally, the candidate must be at least 18 years of age.

If an individual intends to continue losing weight, it is advisable to postpone surgery until they reach their desired weight. A panniculectomy offers an option for people who have lost a significant amount of weight but do not wish to undergo an abdominoplasty.

Before a panniculectomy procedure takes place, the person will likely undergo a medical evaluation by a doctor, which may also involve some lab tests.

A person may need to adjust any current medications. Alternatively, a doctor may prescribe certain medications for the person to take before the procedure. They may also advise the person to avoid taking anti-inflammatory drugs, such as aspirin, or herbal supplements, as these may increase bleeding.

As cigarette smoking can affect wound healing and the blood supply, it is necessary to stop smoking before the procedure takes place. Active smokers are not candidates for a panniculectomy. A doctor will also recommend that an individual maintain a stable weight for 6–18 months before the procedure.

A person should arrange for someone to drive them home after the surgery is complete. They should also ensure that someone stays with them for at least the first night after surgery.

A surgeon will perform the panniculectomy procedure, which they will begin by administering anesthetics. These medications put a person to sleep and prevent them from feeling pain during surgery. The medical team will choose the most suitable anesthetic for the person.

The procedure itself will involve an incision in the area between the bellybutton and the pubic hairline. The shape and length of the cut will depend on the amount of extra skin that the surgeon aims to remove.

The surgeon will cut deeper until they get down to the muscle. Following this, they will pull down and remove the excess skin and fat before using sutures to close the wound. Before closure, the surgeon may place suction drains to prevent excess fluid from accumulating. They may also reposition the bellybutton stem and pull it through the new opening of the abdomen.

A panniculectomy is different from an abdominoplasty, which is also known as a tummy tuck. Although the procedures are similar, they are distinct.

A tummy tuck is a type of cosmetic surgery that aims to remove excess skin and fat from the abdominal region and strengthen the abdominal wall. It also involves stitching the two sides of the rectus abdominis muscle together. A panniculectomy is a functional surgery that aims to minimize the complications of the excess skin and fat by removing them.

A 2022 retrospective study found that a panniculectomy was more likely to lead to complications than a tummy tuck. Complications that a person may experience include:

  • infections
  • wound separation
  • sepsis
  • bleeding
  • readmission to hospital
  • re-operation

After surgery, a person may need to stay in the hospital for a few days. After the anesthesia wears off, medical staff may ask the individual to get up and walk a few steps. It is common to experience some pain and swelling, so a doctor will likely prescribe pain relievers. The person may also benefit from resting with the legs and hips bent to reduce pressure on the abdomen.

A person may also receive a compression garment to wear. This reduces swelling and supports the abdomen while it heals. The surgeon may also place small temporary drains under the skin to drain any excess fluid that accumulates.

A person is likely to start noticing the results of the procedure within 1–2 weeks. They may not be able to return to work for several weeks and should avoid strenuous activities for 6–8 weeks. It can take a few months for the swelling to go down and the wounds to heal. In some cases, it may take a couple of years for scars to fade and for a person to see the final results of the surgery.

A panniculectomy is typically a successful procedure, but it does have a high complication rate. A 2021 retrospective review found that the procedure has a 22.3% postoperative complication rate. According to the study, people with a higher body mass index (BMI) and those who smoke have an increased risk of postoperative complications.

Potential panniculectomy complications include:

  • poor wound healing
  • fluid collecting under the skin
  • skin infections
  • abscesses
  • blood collecting under the abdominal flap
  • wound separation
  • injury to the blood supply of the abdomen
  • blood clots

The cost of a panniculectomy can vary depending on a variety of factors, including:

  • the location of the surgeon or clinic
  • the level of experience of the surgeon
  • hospital fees and costs
  • prescriptions for medication
  • medical tests and X-rays
  • the amount of excess skin and fat that the surgeon will remove

Anecdotal sources suggest that the cost of the surgery is in the range of $7,000–18,000.

A person’s insurance provider may cover the procedure. However, this will depend on several factors, such as whether the procedure is cosmetic or medically necessary and whether symptoms such as skin irritation respond to medication.

A person should check with their insurance provider regarding these requirements. In some cases, they might need to provide a letter from their primary care physician confirming that the procedure is medically necessary.

A panniculectomy is a surgical procedure that aims to remove overhanging excess skin and fat from the lower abdomen, which is known as a panniculus. This may occur after significant weight loss, such as after bariatric surgery.

The procedure involves cutting the excess skin and suturing the remaining skin together. This procedure differs from a tummy tuck as it is a functional surgery and not cosmetic. Additionally, unlike a tummy tuck, the surgeon will not strengthen and tighten the abdominal wall muscles during a panniculectomy.

Recovery may take several weeks or months, and it may take up to 2 years for a person to see the final results. As it is a functional surgery, a person’s insurance may cover some costs of the procedure. However, a person will need to speak with their insurance provider to determine whether their insurance plan covers a panniculectomy.