Panniculectomy Surgery: Procedure and Recovery

A panniculectomy is surgery to remove excess skin from the lower abdomen. It is different from a tummy tuck, which is a cosmetic procedure that removes excess skin and fat and tightens the abdominal muscles.

A panniculectomy is elective surgery performed to relieve symptoms from an overhanging apron of skin. The excess skin can irritate and interfere with everyday activities. It's usually the result of significant weight loss.

This article discusses what a panniculectomy is and when it's recommended. It also covers what to expect during surgery and recovery.

What Is a Panniculectomy?

A panniculectomy is the surgical removal of stretched-out, overhanging skin and fat from the lower abdomen (such as the pannus or apron).

The surgeon makes a horizontal incision above the pubic area between the hips. They may make another cut from the breast bone to the pelvic bone to remove the fat and extra skin.

The surgery may be performed as either an inpatient or outpatient procedure. You and your surgeon will schedule this elective surgery if you are determined to be a good candidate.

Who Should Get a Panniculectomy

Your healthcare provider may recommend a panniculectomy if you have excess skin and fat on the lower abdomen that hangs over your thighs.

Excess skin can be caused by weight loss through gastric bypass surgery or lifestyle changes. It may also be caused by aging, prior surgery, pregnancy, or heredity.

It can cause sores and rashes and interfere with daily activities like walking or personal hygiene. A panniculectomy can help prevent recurring skin irritations and infections underneath the skinfold.

Candidacy

You may not be a good candidate for panniculectomy if you have another medical condition that's not well controlled. This can include diabetes, cardiac disease, and lung disease. Obesity may also raise your risk of complications. You may also not qualify for skin removal surgery if you smoke.

Panniculectomies are often performed on adults and, in some cases, adolescents following bariatric surgery for weight loss. You should generally be at a stable weight for six months before undergoing a panniculectomy.

If you’re planning to lose more weight, your healthcare provider will likely suggest postponing the surgery until your weight has become stable.

Panniculectomy Alternatives

If you aren't a good candidate for a panniculectomy, your healthcare provider may recommend alternative procedures, such as an abdominoplasty. This procedure removes unwanted skin and fat and tightens the abdominal muscles. 

Some people may also be better candidates for liposuction. Liposuction is used to improve the appearance of loose, fatty skin. 

Potential Risks

The risks for a panniculectomy include:

• Loose skin
• Scarring
• Skin loss
• Nerve damage
• Infection
• Poor wound healing
• Fluid buildup
• Tissue death

How to Prepare

Before the skin removal surgery, you’ll schedule an appointment with the surgeon. This allows you to ask questions about the surgery, including the risks and typical results. In addition, you can ask about their medical background, including expertise and training in panniculectomy surgery.

You should also arrange for someone to bring you home after the procedure. You may wish to have someone stay with you for at least the first night after the procedure while you recover.

Cost and Health Insurance

Your panniculectomy may be covered by insurance if your condition causes medical issues such as rashes or ulcers that haven't responded to treatment. It also may be covered by your insurance plan if the excess skin interferes with daily activities and can be corrected with surgery. If your panniculectomy isn't medically necessary, you'll likely pay for it out of pocket.

If applicable, check with your insurance provider ahead of time to find out what will and will not be covered.

Location

Your panniculectomy will likely be performed in a hospital or licensed ambulatory surgical setting.

What to Wear

Wear or bring loose-fitting clothing that you can easily change in and out of. You'll wear a hospital gown for the procedure.

Food and Drink

Follow your surgeon’s instructions about when to stop eating and drinking before the surgery.

Medications

Several days before the skin removal surgery, your healthcare provider may ask you to stop taking certain medications. For example, aspirin, Advil (ibuprofen), Jantoven or Coumadin (warfarin), and other medications could cause problems with bleeding. Ask your healthcare provider if you should continue taking any medications on the day of the surgery.

What to Bring

Make sure you remember any paperwork and your health insurance card. Also, bring a change of clothes if you want a separate outfit to wear home or if you’re spending the night. Remember to make arrangements for someone to drive you home after the surgery.

Pre-Op Lifestyle Changes

Surgeons often recommend quitting smoking at least three to six weeks before skin removal. Smoking reduces blood flow and oxygen. It can cause tissue death, delayed wound healing, blood clots, and life-threatening complications such as strokes.

To avoid complications, ask your surgeon about your risk before scheduling surgery.

What to Expect on the Day of Surgery

Before the panniculectomy, a nurse will check your vitals and ask about your medical history. You’ll receive general anesthesia so that you are asleep and unable to feel any pain.

During the Surgery

An incision will be made that runs horizontally in the area between your belly button and the pubic area. Excess skin and fat will be cut out with a scalpel or other surgical instruments through the horizontal incision.

Sometimes, the surgeon will also make an incision that runs vertically if you have excess skin and tissue in the transverse (side-to-side) dimension.

The remaining upper abdominal skin is then pulled down, and the incision is closed with sutures. Thin tubes called drains may temporarily be inserted under the skin to prevent the buildup of fluids.

The procedure usually takes three to five hours to complete, depending on how much skin and fat are removed. Talk with your healthcare provider before the skin removal surgery to confirm the techniques used.

After the Surgery

You’ll be monitored in the recovery area after the panniculectomy. When you recover from anesthesia, you may be asked to get up and walk a few steps. Depending on the extent of your surgery, you may be able to go home that day when you’re medically stable. In some cases, you may have to stay at the hospital for up to two days.

Your incision will be covered with gauze dressing or bandages. After a day or two, your healthcare provider may have you wear an elastic support or compression garment to help support the abdomen as it heals.

Recovery

Patients will experience pain and swelling for a few days after the procedure. Your healthcare provider will give you pain medication to help manage your discomfort.

If you have drains, your healthcare provider will give you instructions for care. This may include recording the amount of fluid in the drains and how to empty them.

Avoid strenuous activity for four to six weeks after the procedure. You will probably be able to return to work within about four weeks.

Your surgeon will let you know when to visit for a follow-up appointment. Removal of drainage tubes may be done at this time.

Healing

You'll likely experience pain, swelling, and bruising for days after the surgery. You may have some numbness and feel tired during this time as well.

To help take some pressure off the abdomen, try keeping your legs and hips bent while resting. Your healthcare provider may recommend waiting to shower until 48 hours after the surgery. It may take up to three months for the swelling to go down and for the wounds to completely heal.

Coping With Recovery

Skin removal surgery can help you feel more confident in your appearance, but it may take some time to get there after surgery. Patients can have significant scarring for more than a year after the surgery. It can take up to two years for scars to fade and to see the intended results.

Studies show those who have skin removal surgeries usually have an adjustment process but tend to be happy with the results.

One study found that patients were self-conscious about their scars and body image for the first year after body contouring surgery. However, those same patients reported improved body image after the first year and less distress about their scarring.

In another study, patients who had body-contouring surgeries were surveyed about their ideal body shape. Their perception of their appearance improved significantly with surgery, even if they identified a thinner shape as ideal. The results indicated they felt encouraged about their appearance and ability to reach their goals.

Summary

In a panniculectomy, the surgeon removes overhanging skin and fat from the lower abdomen. Usually, this happens after you've had dramatic weight loss, especially from gastric bypass surgery or lifestyle changes.

Your healthcare provider may decide you're a good candidate for the surgery if the excess skin is causing repeated irritation or infection. It's not recommended for purely cosmetic reasons.

A panniculectomy may be performed as an outpatient or inpatient procedure, and usually takes between three and five hours. It may take up to three months for the wounds to completely heal.

A Word From Verywell

Ask your healthcare provider any questions you have about the panniculectomy, your recovery time, and the results you can expect. Panniculectomy is a major surgery that can require weeks or months to fully heal. However, if you're dealing with extra skin after weight loss, surgery can help improve your health and quality of life.