What is a panniculectomy?
A panniculectomy is a surgical procedure that removes excess skin and fat from the lower abdomen. It is sometimes referred to as an “apronectomy” because the hanging flap of tissue removed resembles an apron. The procedure is performed on patients who have excess skin and fat in the lower abdominal area, often as a result of massive weight loss from bariatric surgery or dieting. The panniculus or pannus may hang down over the pubic region and upper thighs, sometimes extending as far as the knees. A panniculectomy removes this pannus and creates a flatter, firmer abdominal contour.
Why is a panniculectomy performed?
There are both functional and cosmetic reasons to have a panniculectomy:
Functional reasons:
- Relieves back pain or irritation caused by the hanging pannus rubbing on skin
- Alleviates poor posture and chronic back strain due to the weight of excess tissue
- Prevents rashes, infections, and ulcers beneath pannus that won’t heal due to lack of air circulation
- Improves mobility and ability to exercise
- Makes personal hygiene easier
Cosmetic reasons:
- Creates a flatter, smoother, more toned abdominal contour
- Allows clothes to fit better
- Improves self-confidence and body image
For many patients, both the functional and cosmetic improvements are meaningful benefits of panniculectomy surgery. Candidates for the procedure include both women and men who have lost a significant amount of weight and have a pannus that causes discomfort, poor hygiene, irritation, or low self-esteem. The surgery is sometimes covered by insurance if the pannus causes documented medical problems or interferes with daily living.
What is an extended panniculectomy?
An extended panniculectomy is a more comprehensive version of a standard panniculectomy. While a traditional panniculectomy focuses on removing the overhanging pannus from the lower abdomen, an extended panniculectomy also includes:
- Lateral thigh lift – Removal of outer thigh skin/fat
- Pubic lift – Removal of skin/fat from pubic region
- Buttock lift – Removal of skin/fat from buttocks
- Back lift – Removal of skin/fat from lower back
The extended panniculectomy treats additional areas that commonly have loose, hanging skin after major weight loss. Removing the excess tissue improves contour throughout the lower body, not just the frontal abdomen. For patients with extensive skin laxity in multiple areas, the extended version can greatly improve comfort, mobility, hygiene, and appearance.
Ideal candidates for extended panniculectomy
The best candidates for an extended panniculectomy include:
- Men or women with a large, hanging panniculus and extensive loose skin in surrounding areas like the thighs, hips, pubic region, buttocks, and lower back
- Patients who have achieved significant weight loss through bariatric surgery or dieting
- Non-smokers in good health who have maintained a stable weight for at least 6 months
- Individuals bothered by functional problems from loose skin that interferes with daily living
- Patients with medical issues like intertrigo or cellulitis under panniculus
- Those with realistic expectations who understand scars are part of surgery
An initial consultation with a board-certified plastic surgeon is the best way to determine if you are suited for an extended panniculectomy. The surgeon will evaluate your health, weight history, amount of excess skin, and goals for surgery. Good candidates should be physically healthy, at a stable weight, and hoping to improve physical discomfort and self-confidence.
What happens during an extended panniculectomy?
An extended panniculectomy is a major surgical procedure performed under general anesthesia. The surgery typically takes 3 to 5 hours.
Here’s a basic outline:
- General anesthesia is administered to put you to sleep
- Incisions are made to outline areas of removal and access underlying tissue
- Excess skin, fat, and tissue are removed from the abdomen, flanks, thighs, pubic area, buttocks, and lower back
- The abdominal muscles may be tightened with sutures (abdominoplasty)
- Remaining skin is re-draped and contoured
- Drains are placed to remove fluid buildup
- Incisions are closed with sutures, skin glue, or tape
- Elastic compression garments are put on to control swelling
The particular techniques used will depend on your specific areas of concern. Your surgeon will determine the appropriate plan based on your needs and goals.
Recovery after extended panniculectomy
It generally takes about 2 to 4 weeks to recover after an extended panniculectomy. Typical guidelines include:
- Hospital stay of 1 to 2 days
- Drainage tubes remain for 1 to 2 weeks
- Prescription pain medication for pain management
- Swelling and bruising peak at about 72 hours, then subside
- Must wear compression garment for about 6 weeks
- No strenuous activity or lifting over 5 lbs for 4 to 6 weeks
- Most return to work within 2 to 4 weeks
- Avoid sexual activity for 2 to 4 weeks
- Scars fade and flatten over 6 to 12 months
Follow all care instructions from your plastic surgeon to ensure proper healing. Schedule follow-up visits to monitor your progress. While recovery takes time and patience, most patients find the final results of extended panniculectomy surgery highly rewarding.
Risks and complications
As with any major surgery, extended panniculectomy carries some risks, such as:
- Bleeding
- Infection
- Adverse reaction to anesthesia
- Blood clots
- Fluid buildup (seroma)
- Skin loss
- Asymmetry
- Persistent swelling or numbness
- Scarring issues
Choosing an experienced, board-certified plastic surgeon practicing in an accredited facility helps minimize risks. Be sure to discuss your complete medical history and ask questions before surgery. Following all pre- and post-operative instructions can also reduce complications.
While seldom needed, a revision surgery may be performed to correct any issues with asymmetry, contours, or scarring. Most patients, however, are pleased with their final extended panniculectomy results. The procedure can dramatically improve appearance, comfort, mobility, and self-confidence.
Cost of extended panniculectomy
The average cost of an extended panniculectomy is $10,000 to $15,000. However, prices can range from $7,500 to $25,000 based on your surgeon’s expertise, the extensiveness of the procedure, and your geographic location.
Factors impacting extended panniculectomy costs:
- Surgeon’s fees
- Extent of procedure/areas treated
- Anesthesia fees
- Hospital or surgical facility costs
- Pre-operative lab testing
- Post-operative garments
- Pain medications
Many plastic surgeons offer patient financing plans to make the procedure more affordable. For patients who meet documentation requirements, insurance may cover some or all of the costs.
Finding a surgeon for extended panniculectomy
It’s important to choose an experienced, board-certified plastic surgeon for your extended panniculectomy. Be sure to:
- Verify board certification
- View before and after photos of their extended panniculectomy results
- Read reviews from former patients
- Ensure they operate in an accredited surgical facility
- Ask about their panniculectomy technique and experience
- Make sure you feel comfortable with them during consultations
An extended panniculectomy is highly customized for each patient. Be wary of discount deals or surgeons offering one-price-fits all arrangements. Your procedure should be tailored to match your particular conditions and aesthetic goals. Investing in an experienced surgeon helps ensure optimal sculpting and safety.
Preparing for extended panniculectomy surgery
Here are some tips for preparing for your extended panniculectomy:
- Get medical clearance from your doctor
- Have pre-operative testing done
- Stop smoking, vaping, tobacco use
- Avoid certain medications/supplements that increase bleeding risk
- Arrange a ride home after surgery
- Stock up on soft, comfortable foods
- Get compression garments, pillows, and recovery items
- Make arrangements for childcare/pet care help
- Take 10 to 14 days off work
- Set up your bed/home for ease of mobility
- Stop shaving/waxing/tanning before surgery
Thoroughly following your surgeon’s pre-operative instructions will help you recover quicker. Make sure you understand all of the steps you need to take before extended panniculectomy surgery.
Extended panniculectomy vs. lower body lift
An extended panniculectomy is somewhat similar to a lower body lift, but there are some differences:
Extended panniculectomy
- Focuses on pannus and lower abdomen
- Also lifts thighs, pubic area, hips, back
- Less invasive than lower body lift
- Shorter incisions
- Quicker recovery
Lower body lift
- Circumferential procedure lifting buttocks, hips, outer thighs, abdomen
- Long incision around torso and thighs
- More extensive surgery and recovery
- Higher cost
For many patients with moderate to severe loose skin limited to the lower body, an extended panniculectomy sufficiently improves contour and appearance. A full lower body lift makes sense for those with more diffuse laxity throughout 360 degrees of the trunk and thighs.
Extended panniculectomy vs. belt lipectomy
An extended panniculectomy and belt lipectomy both remove lower abdominal skin but have some differences:
Extended panniculectomy
- Removes pannus and includes thigh, pubic, buttock, back lift
- Reshapes multiple areas of lower body
- Leaves horizontal scar across lower abdomen
Belt lipectomy
- Removes lower abdominal skin and fat only
- Does not address other areas like thighs or buttocks
- Leaves a circumferential scar around the waistline
While a belt lipectomy focuses just on the abdomen, an extended panniculectomy also improves contour of the hips, outer thighs, pubic area, buttocks, and back. The choice depends on your specific treatment goals.
Finding motivation for extended panniculectomy
Here are some motivational tips to help you take the step toward extended panniculectomy:
- Focus on how much it will improve your comfort and mobility
- Remember the boost in confidence you’ll feel
- Look at panniculectomy before and after pictures
- Imagine the relief from skin irritation and infection
- Focus on your new ability to exercise and be active
- Picture buying new clothes that fit well
- Think about no longer being self-conscious about your appearance
- Watch video testimonials from patients
- Trust your surgeon’s advice and experience with the procedure
- Know the rewards are worth the short-term recovery period
Improving severe functional problems or profound distress over appearance can provide powerful motivation. Focusing on your expected results and renewed quality of life can help overcome any anxiety about surgery. Your surgeon’s support team can also provide resources to guide you through the process.
Conclusion
An extended panniculectomy is a body contouring surgery that removes excess, hanging skin and fat from the abdomen, thighs, hips, pubic area, back, and buttocks. It is an option for patients who have lost significant weight and have diffuse loose skin affecting areas beyond just the pannus. The procedure can dramatically improve comfort, mobility, hygiene, and appearance.
Ideal candidates are men and women struggling with functional impairment or embarrassment from loose, overhanging skin after weight loss. An extended panniculectomy is customized to address a patient’s particular problem zones through strategic excision and lifting.
While recovery takes 2 to 4 weeks, most patients achieve rewarding, life-changing improvements from extended panniculectomy surgery. Working with an experienced, board-certified plastic surgeon helps ensure a safe, successful procedure and a sculpted, rejuvenated lower body contour.
