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Panniculectomy Surgery (Abdominoplasty)

Panniculectomy surgery is a reconstructive procedure performed to remove a panniculus, sometimes referred to as a pannus or abdominal apron. The pannus frequently contributes to a number of health concerns, including chronic wounds. Panniculectomy surgery becomes necessary for many patients who have had massive weight loss as a result of successful bariatric weight-loss surgery. Bariatric weight-loss surgery is one of the fastest growing specialties in America, and therefore, nurses can expect to care for increasing numbers of patients who require this reconstructive procedure. Despite the medical necessity of panniculectomy surgery, barriers to reimbursement exist. An update on the demographics of obesity, nationally and worldwide, are presented, especially as this information relates to the growing interest in panniculectomy surgery following massive weight loss. Bariatric weight-loss surgery and panniculectomy surgery are described and barriers to reimbursement are explained. The importance of wound care documentation in making the case for reimbursement is described, and a sample letter of appeal is provided.

Panniculectomy excises the abdominal pannus. In addition to panniculectomy, a reconstructive abdominoplasty, which involves the anterior muscle wall and fascial plication, is usually performed. A suction lipoplasty may improve the reconstructed abdominal wall contour; the patient may also undergo umbilical or ventral hernia repair. In panniculectomy, the incision creates a scar from the xiphoid process to the pubic bone. There it meets a second, horizontal scar, just above the pubic area, to form what looks like an inverted letter “T.” To create this “T,” the surgeon frees up fat and skin from the anterior abdomen. At that point, a large triangularly shaped area of loose skin and excess fat is carefully removed. The remaining tissue is then attached to the anterior abdominal wall and to itself. A number of procedures can be completed at the same time, such as exploratory laporatomy, revision of the primary surgery, or repair of abdominal wall/ventral hernia.

Who are the Best Candidates for a Panniculectomy surgery ?

When a patient loses large amounts of weight, the skin does not retain its shape, leaving the patient with a large hanging apron of excess skin and fat below the stomach area, otherwise known as a pannus," said Ernest Manders, MD, ASPS member. "By focusing on patients who undergo a panniculectomy to remove the pannus, we found significantly fewer complications in patients who had the procedure one year after bariatric surgery rather than during the initial surgery

Are you still planning to lose a lot of weight?

Waiting one year and allowing an interval for weight loss after the surgery, has a number of benefits over the simultaneous procedure. There were significantly fewer complications for patients who waited one year, including fewer wound infections and less wound reopening. Of the 123 patients studied, there was no respiratory disease or deaths among patients who waited after bariatric surgery. In addition, 20 percent of patients who had a panniculectomy during bariatric surgery had the surgery repeated later due to additional weight loss.

Patients who waited fared much better than those who did not because their bodies were healthier going into the panniculectomy, according to Dr. Manders. Many of the patients studied had lost about 100 pounds, gotten their diabetes under control, reduced their hypertension and lowered the stress on their hearts, making the surgery much safer and decreasing the risk of complications.

How is a Panniculectomy Surgery Done?

This surgery is similar to a tummy tuck but is more complex. Panniculectomy cuts out the large abdominal apron of fat that hangs down in obese people or those who have lost a great deal of weight.

Home Care After Panniculectomy

Please follow these instructions in addition to those listed on the General Home
Care After Plastic Surgery sheet you received. Abdominoplasty / Panniculectomy

If you have steri strips (butterfly tapes) on your incision, leave them in place until your first doctor’s visit after the surgery.If you have drains, empty them as instructed. Record the amount of drainage and reapply the suction 2 times a day. Sponge bathe daily until the drains are removed, then you can shower. Wash your wound with soap and water and pat it dry once a day. Clean around the drains once a day and replace the dressings. If the dressings are soiled, they can be replaced more often. Do not lift anything over 10 pounds for 6 weeks. This includes children and pets. Do not put pressure or weight on your abdomen for 6 weeks. Wear an abdominal binder, if provided, 24 hours a day until you return for your first doctor’s visit after surgery. You may remove it to clean your wound.

As expected, you will have pain and swelling in the days following surgery. Your doctor can prescribe a painkiller if needed, and will instruct you on how to best handle the pain.

Soreness may last for several weeks or months. You may also experience numbness, bruising and overall tiredness for that same time period.

As with any surgery, there are risks. Remember, this surgery affects a very crucial part of your body. Though they’re rare, complications can include infection, bleeding under the skin flap, or blood clots. You may carry an increased risk of complications if you have poor circulation, diabetes, or heart, lung or liver disease.

You may experience insufficient healing, which can cause more significant scarring or loss of skin. If you do heal poorly, you may require a second surgery. As we mentioned before, the scars from a tummy tuck are fairly prominent, and though they may fade slightly, they will never completely disappear. Your surgeon may recommend certain creams or ointments to use after you’ve completely healed to help with the scars.

Return to Living

Generally, most people love the new look after they’ve undergone this procedure; however, you may not feel like your normal self for months after the surgery. You’ve gone through a tremendous amount to make this happen, both emotionally and spiritually, and it’s very important that you follow proper diet and exercise to maintain your new look.

Does Insurance Cover a Panniculectomy Surgery?

Be warned: Insurance carriers generally do not cover elective, cosmetic surgery. But, your carrier may cover a certain percentage if you have a hernia that will be corrected through the procedure, or your anterior muscles are abnormally spread. It’s extremely important that you begin communicating with your insurance company early on, and that you discuss your insurance concerns with your surgeon. In most cases, your surgeon will write a letter to your insurance carrier, making the case for medical necessity, if it applies to you. It’s also very important to realize that insurance may only cover certain portions of the surgery, so make sure you get details. With any cosmetic surgery, this may affect future insurance coverage for you and your premiums may increase.

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Home > Tummy Tuck> Panniculectomy Surgery Information

Buckhead Plastic Surgery
Specialists in Plastic Surgery North Carolina
Tom Haas, M.D.