Panniculectomy / Abdominoplasty
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Panniculectomy is the medical term for the surgical removal of excess abdominal tissue which in lay term is called the “apron” or pannis. The Pannis is a redundant layer of skin and fat at the lowest portion of the abdominal wall. Because fat distribution is never even in all individuals, some people have significant deposit of fat at this most dependent part of the abdominal wall which further aggravates various complications especially back and joint pain. The “apron” (pannis) in an individual may weigh as little as 5 pounds, or as much as 120 pounds.
After the majority of your weight loss, “tummy tuck” abdominoplasty and panniculectomy can tighten loose sagging tissues. This surgery is designed to
remove and re-drape redundant lower and middle abdominal wall skin and fat. An incision above the pubic region and extending towards the hips places the scar where it can be hidden by most clothing. The skin and fat are separated from the underlying fascia (layer covering the muscles of the abdominal wall). In the standard operation this dissection continues up to the ribs exposing the vertical muscles (rectus muscles). The skin around the belly button (navel or umbilicus) is divided so the redundant tissue of the upper abdomen can be pulled down. This hole will frequently be pulled far enough down to be removed with the excess tissue. When less tissue needs to be removed, this hole may become a short vertical component of the lower scar. The abdominal wall muscles are then drawn together in the midline narrowing the waistline. This stitching firms the abdominal wall and removes some bulging. If you are also having a hernia repair it will be dealt with at this time.The repair of a hernia depends on the size of the hernia. The standard method of hernia repair involves making an incision in the abdominal wall. Hernia repair done concurently with a panniculectomy may include a midline incision as well as a “bikini line” suprapubic incision. Conversely, there may be no additional incision, other than the suprapubic incision, when the hernia repair is done concurently with the panniculectomy. This area, the hernia, is then repaired with sutures. Often a prosthetic material such as mesh, another plastic or biological material is sutured in place to strengthen the area and close the defect.
The skin flap is then stretched down, the extra skin, underlying fat and tissue is removed. A new hole is cut for the navel, if you choose to transplant your navel, and contoured to create its shape. There are other options that can be discussed with your surgeon for the look of a navel without the possible complications of the transplanted navel not taking in its new location.
There may also be some degree of Mons Pubis (the mound of fatty tissue just covering the pubic bone just above the pubic area) lift after panniculectomy.
The tissues are then sewn into place. Special tape strips may further align the skin. Temporary drain tube(s) are placed to remove fluid from under the flap. If present, you will be shown how to record the output from these drains. Dressings applied usually include one around the new navel and one over the main incision. You will be wearing an elastic garment around your abdomen. You will need to wear this support garment for about six weeks after the surgery. It helps to decrease swelling and promotes healing in the area. Complete abdominoplasty and panniculectomy usually takes two to three hours, depending on the extent of work required. Please see the PDF file above for further information.