What is Panniculectomy

Panniculectomy is a type of surgery to remove extra skin and fat tissues that hang from the abdomen (panniculus). The panniculus usually appears after weight loss surgery.

The panniculus may cause problems. It can hang over the genitals and thighs and make it difficult to keep those areas clean. You may have infections, rashes, skin disorders, pain, or poor hygiene due to the panniculus. The panniculus may be referred to as an “apron” of skin.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.
• Whether you smoke or use tobacco.
• Any nutrients you lack (nutrient deficiencies). Having a history of weight loss surgery raises the risk of nutritional deficiencies.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Blood clots.
• Venous thromboembolism (VTE). This is a blood clot that starts in a vein.
• Seroma. This is a pocket of fluid that forms under your skin.
• Scarring.

What happens before the procedure?

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Ask your health care provider if you need to lose more weight before the procedure. Being overweight can raise the risk of problems.
• You may be asked to shower with a germ-killing soap.
• Plan to have someone take you home from the hospital or clinic.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• Incisions will be made in your panniculus, abdomen, or pubic area.
• Excess fat and skin will be removed.
• Drainage tubes will be placed near your incisions to drain fluid from the surgical area.
• Your incisions will be closed with stitches (sutures). Bandages (dressings) may be placed over the incisions.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will need to stay in the hospital after the procedure. Ask your health care provider how long you will stay.
• You may have some pain. You will be given pain medicine as needed.
• You will continue to have drainage tubes in place.
• Do not drive for 24 hours if you were given a sedative.

Summary

• A panniculectomy is a type of surgery to remove the panniculus.
• Infection and bleeding are the most common risks of this procedure.
• You will need to stay in the hospital after the panniculectomy. Ask your health care provider how long you will stay.

Panniculectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common for you to have:

• Pain, swelling, and bruising around your incisions.
• Some drainage of fluid or blood from your incisions.
• Scarring.

Follow these instructions at home:

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision areas every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed antibiotic medicine, take your antibiotic as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Driving

• Do not drive for 24 hours if you were given a medicine to help you relax (sedative).
• Do not drive or use heavy machinery while taking prescription pain medicine.

Activity

• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that your health care provider tells you, until he or she says that it is safe.
• Avoid activity that requires a lot of energy, such as exercise or sports, for at least 6 weeks or as told by your health care provider. Ask your health care provider what activities are safe for you.
• Avoid sexual activity until your health care provider says it is safe.

Lifestyle

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Avoid drinking alcohol.

General instructions

• Follow instructions from your health care provider about how to take care of your drainage tubes. Do not remove your drainage tubes unless told by your health care provider.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Do not take baths, shower, swim, or use a hot tub until your health care provider approves. You may need to take sponge baths.
• If you were given an abdominal binder or girdle, wear it at all times, except when bathing. This includes when you are sleeping. Wear your abdominal binder or girdle for as long as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have more fluid or blood coming from an incision than normal.
• An incision feels warm to the touch.
• You have a fever.
• You have severe pain, and medicines do not help.

Get help right away if:

• You have pus or a bad smell coming from an incision.
• You have more redness, swelling, or pain around an incision.
• An incision starts to break open.
• You have chest pain.
• You have problems with breathing.

Summary

• After the panniculectomy, it is common for you to have pain, swelling, and bruising.
• Check your incision areas every day for signs of infection.
• Do not remove your drainage tubes unless told by your health care provider.