Length of Surgery
$6,800 Plus HST
Panniculectomy is a reconstructive surgical procedure which removes excess skin from the lower abdominal edge. This procedure is suitable for patients after massive weight loss through natural means or bariatric surgery.
Summary of Surgery:
Type of Anesthesia:
2 weeks off from work
6 weeks before resuming physical activity
Table of Contents
What is a Panniculectomy?
A panniculectomy is a reconstructive surgical procedure that remove the excess skin apron (pannus) in the lower abdominal area after major weight loss. A panniculectomy is not a tummy tuck (abdominoplasty), which is a more complex procedure performed for cosmetic and aesthetic reasons. Patients with stable weight loss for more than 6 months, skin maceration, ulceration, pain, frequent infections, back strain or other physical limitations as a result of their pannus may be eligible for OHIP coverage.
Because a panniculectomy is a medically necessary procedure, rather than a purely cosmetic intervention for aesthetic reasons, the medically necessary portions of the procedure are covered by OHIP if you meet the above criteria. During the initial consultation, Dr. Chivers will assess you, give you a thorough examination and review your medical history. He will determine whether this procedure can provide relief from any symptoms you are experiencing and he will make sure you fully understand your options before proceeding.
OHIP Coverage for Panniculectomy
Panniculectomies are performed for medical reasons and covered by OHIP if the above criteria are met. However, a panniculectomy is only strictly the removal of the lower skin flap which often results in a distorted abdomen. Patients may continue to have a low hanging belly button, residual fat and skin flaps in the upper abdomen below the breast/chest region, protrusion of the flanks and mid-abdominal region as a result of diastasis rectis (separation of the abdominal muscles).
Cosmetic elements in addition to the removal of the lower skin apron, such as flank liposuction, abdominal muscle tightening and/or repositioning of the belly button are not covered by OHIP. At the Canadian Plastic Surgery Centre, a panniculectomy is always combined with these cosmetic elements to provide patients with the best aesthetic outcomes.
Panniculectomy surgery is suitable for patients after massive weight loss. You may want to consider this surgery if:
you are in good health
you have undergone major weight loss and have been at a stable weight for greater than six months
you have overhanging skin in the lower abdomen that is interfering with the activities of daily life
you have medical symptoms from your excess abdominal apron, such as physical restrictions, irritation, chafing, rashes, open sores and possibly even infections
Dr. Chivers will determine this and discuss your surgical options with you during your initial consultation, along with any cosmetic concerns you may additionally want addressed. Canadian Plastic Surgery Centre may be just what you need to be able to help you live a more comfortable life.
Can a Panniculectomy HELP me lose weight?
One common misconception is that a panniculectomy is a weight loss procedure. It is not. While some excess external fat (subcutaneous fat) is removed, the amount of weight lost from the procedure is not significant. The purpose of a panniculectomy is to remove the lower pannus from the abdominal area. If you are looking to lose weight for health reasons, a viable option is to undergo bariatric surgery (i.e. gastric bypass or gastric sleeve) or through natural means, such as diet and exercise. It is through these methods that fat within the abdominal compartment (visceral fat) is reduced contributing to weight loss. Visceral fat cannot be removed by surgical means.
The difference between subcutaneous fat and visceral fat and why it makes a difference.
The difference between subcutaneous and visceral fat is mainly the location of the fat in the body, but each type of fat has different health implications. Subcutaneous fat is found directly beneath the skin, whereas visceral fat is found within the abdominal compartment, located between and around your organs. Although unsightly, subcutaneous fat has limited implications on an individual’s health. However, individuals with large amounts of visceral fat are found to have an increased risk for cardiovascular disease, diabetes, colorectal cancer and other chronic illnesses. Subcutaneous fat is located in areas that can be molded and operated on through liposuction or excised by cosmetic plastic surgeons, whereas visceral fat is inaccessible.
This has considerable implications for patients who would like to undergo panniculectomy/abdominoplasty surgery to reduce their abdominal girth. Although subcutaneous fat can be removed through body contouring procedures, visceral fat that causes a large abdominal girth can only be lost through diet, exercise or with the help of bariatric surgeries. Panniculectomies are therefore typically an option for patients after massive weight lost who are at a stable weight for greater than 6 months.
For this procedure, you will be put to sleep under general anesthesia. During a panniculectomy, the pannus or panniculus (abdominal apron consisting of fat tissue covered by skin) is excised. After the excess skin has been removed, the skin is pulled tighter and the wound is sutured closed with dissolvable stitches (no staples are used). While the overhanging excess skin is no longer there after the procedure, the weakened abdominal musculature and excess fat and soft tissues above the umbilicus or along the flanks is remaining.
It is recommended that patients combine a panniculectomy with cosmetic elements such as abdominal muscle tightening, flank liposuction and contouring, and abdominal contouring to improve aesthetic outcomes.
Panniculectomy vs. Abdominoplasty
A panniculectomy is sometimes mistaken for an abdominoplasty as both remove skin from the lower abdomen. Panniculectomies are medically necessary procedures that remove excess skin in the lower part of the abdomen that is the result of massive weight loss. Abdominoplasties or tummy tucks are solely performed for cosmetic purposes and removal a smaller amount of excess skin that is hard to lose after pregnancy or some weight gain. It involves the tightening of the mid-abdominal region, liposuction of the flanks, and repositioning of the belly button.
Recovery from an abdominoplasty typically requires 6 weeks. However depending on the extent of the procedure, a patient may recover faster from surgeries that are less extensive.
Post- Operative Instructions at a Glance
Dressings are changed the day after surgery and at 1 week.
Pain medication and antibiotics are prescribed for the first week following surgery. Any post-operative pain is typically mild to moderate.
Patients are able to walk the day after surgery.
Drains inserted during the procedure are painlessly removed at 1 week.
Incisions are to be kept dry for the first week. Patients can shower after that.
Patients are able to return to light duties at work typically after 2 weeks.
Ends of dissolving sutures are trimmed at 3 weeks.
Abdominal binder given to the patient is to be worn for 6 weeks and until the final follow-up.
Patients are able to resume full activities and to exercise after 6 weeks.
Immersion of incisions in baths, hot tubs, pools, oceans should be avoided for 6 weeks.
Consent form and Lists of Complications:
After massive weight loss, a lot of patients are affected by loss of volume and sagging in the breasts. Breast lift is a common complimentary procedure as it helps bring tissue upward to create volume in the upper pole of the breast and treats irritation and maceration in the skin folds beneath the breasts.
Breasts, composed of fatty tissue and mammary glands, fluctuates with an individual's weight. Some women continue to have large breast even after weight lost which can interfere with daily activities and cause health problems such as back and should ache. Breast reduction is one way to help women with this problem.