Definition & Overview
An infraumbilical panniculectomy is the excision of excessive skin and subcutaneous tissue in the abdomen. It can be combined with lipectomy, which is the surgical removal of fatty tissue from different body parts, including the abdomen, to achieve better cosmetic results.
An infraumbilical panniculectomy with lipectomy is performed to remove the overhang of skin and subcutaneous fat that commonly appears in the lower abdominal area, which is called the panniculus. The procedure often becomes necessary for overweight or obese patients.
A panniculectomy can be performed either for medical or cosmetic reasons. There are some criteria that have to be met for it to be considered medical in nature. Unless such criteria are met, the procedure is deemed cosmetic.
Who Should Undergo and Expected Results
An infraumbilical panniculectomy with lipectomy is a medically necessary procedure for obese and overweight patients with a panniculus. These patients typically present with the following symptoms in their lower abdominal area:
- Excess skin
- Stretch marks
- Open wounds below the skin folds
Patients who have a panniculus may find it difficult to maintain good hygiene in the lower abdominal area. The excess skin can also interfere with movements in severe cases.
An infraumbilical panniculectomy becomes medically necessary if the following conditions are met:
- The panniculus hangs up to or even below the pubic symphysis
- The patient has lost weight but still suffers from a panniculus for at least one year
- The panniculus impairs movements or hinders the patient from having a normal life
- The panniculus causes complications that do not respond to treatment within six months, such as:
- Tissue necrosis
- Chronic intertrigo
- Exfoliative dermatitis
- Febrile neutrophilic dermatosis
- Other erythematous conditions
A panniculus is also medically removed if it deforms the abdominal region. The degree of deformity is graded based on the size of this “apron of skin”.
- Grade 1 – The panniculus reaches the pubic hairline but not the genitals.
- Grade 2 – The panniculus covers the genitals.
- Grade 3 – The panniculus covers the upper thigh.
- Grade 4 – The panniculus covers the middle thigh.
- Grade 5 – The panniculus reaches down to the knees (or even below).
On the other hand, infraumbilical panniculectomy with lipectomy is considered cosmetic in nature when combined with any of the following procedures:
- Abdominoplasty – A surgical procedure used to remove excess fat and skin from the abdominal area.
- Umbilical transposition – A surgical procedure that improves the appearance of the belly button.
- Fascial plication – A procedure that tightens the abdominal muscles.
A panniculectomy is also not medically necessary if it is used only to:
- Relieve neck and back pain caused by spinal stress
- Improve a patient’s post-pregnancy body after childbirth
How is the Procedure Performed?
A surgeon performs an infraumbilical panniculectomy with lipectomy with the following steps:
- The patient is placed under general anaesthesia.
- The surgeon makes a hipbone-to-hipbone incision above the pubic area.
- The surgeon then removes a wedge of excess skin and subcutaneous tissue. In a basic panniculectomy, the surgeon is not concerned about the appearance of the abdomen. This means that the abdominal muscles and the belly button are left untouched.
- The patient will be asked to stay in the hospital overnight. Pain can be managed with oral pain medications.
- The doctor will check on the patient the day after the procedure. During this initial post-operative checkup, the dressing on the wound is changed. The wound is also checked for signs of severe bleeding or fluid collection.
- If the surgeon had placed drains on the wound, the patient is asked to go back a week after to have them removed.
The whole procedure can take anywhere from two to five hours depending on the severity of the patient’s condition. It can be performed alone or in combination with other procedures that can improve the appearance of the abdominal area.
In a cosmetic panniculectomy, the surgeon may also perform surgery on the abdominal muscles, which are often widened due to the excess weight and tissue of the panniculus. The surgeon may even relocate the belly button. If these procedures are performed, the surgery is closer to an abdominoplasty rather than a panniculectomy.
Possible Risks and Complications
Patients who undergo an infraumbilical panniculectomy are at risk of:
- Blood clot
- Injury to the blood vessels and nerves
- Injury to the surrounding structures
- Poor cosmetic result
- Deep venous thromboembolism
- Pulmonary embolism
- Fluid buildup
- Allergic reaction to anaesthesia
In some cases, the patient may require a revision surgery.
Salunke AA, Rajkumar KS, Nambi GI, Chaudhari VA. “Massive panniculectomy: A novel method of treatment of postlaparotomy wound dehiscence in morbid obesity.” Can J Surg. 2014 Apr; 57(2): E53-E54.
Micha JP, Rettenmaier MA, Francis L, Willenberg R, Brown JV. “Medically necessary panniculectomy to facilitate gynecologic cancer surgery in morbidly obese patients.” Journal of Pelvic Surgery. 1999 January; 5(1): 61.