A panniculectomy is a surgical procedure to remove excess skin and fat from the lower abdomen. This excess skin and fat below the abdomen is called a pannus or panniculus. A panniculectomy is often performed on patients who have lost a significant amount of weight and have excess skin that hangs down over their pubic area.
The pannus can cause rashes, infections, difficulty with mobility, poor hygiene, and lower back pain. A panniculectomy removes this excess tissue and can greatly improve a patient’s quality of life. However, because it is a major surgical procedure, doctors have guidelines regarding a patient’s health and fitness level before recommending the surgery. One factor is the patient’s body mass index or BMI.
What is BMI?
BMI stands for body mass index. It is a measurement that uses a person’s height and weight to estimate their total body fat. BMI is calculated by dividing weight (in kilograms) by height (in meters) squared.
For example, if a person weighs 80 kg and is 1.75 meters tall, their BMI would be:
80 kg / (1.75 m x 1.75 m) = 26.1
BMI provides a guideline for whether a person’s weight is in a healthy range for their height. The standard BMI ranges are:
BMI | Weight Status |
---|---|
Below 18.5 | Underweight |
18.5 – 24.9 | Normal or Healthy Weight |
25.0 – 29.9 | Overweight |
30.0 and Above | Obese |
In general, a BMI between 18.5 and 24.9 is considered healthy. A BMI of 25-29.9 is overweight, and 30 or above is obese.
Is there a BMI requirement for panniculectomy?
When it comes to panniculectomy, BMI is an important factor surgeons consider. However, there is no definitive BMI cutoff or limit for patients to qualify for the procedure. Instead, surgeons evaluate patients on a case by case basis.
Some plastic surgeons suggest patients should ideally have a BMI below 30 before the surgery. A BMI of 30-35 with no major health problems may still be considered, but the surgical risks increase with higher BMIs.
For patients with a BMI above 35, most surgeons recommend losing weight first before the panniculectomy. This is because:
- Higher complication risks – Obese patients are at greater risk of bleeding, infection, wound healing problems, and other surgical complications.
- Poor skin retraction – Obese patients tend to have poor skin elasticity. After surgery, excess skin is more likely to sag rather than tighten up nicely.
- Recurring pannus – Patients with very high BMIs often regain weight and fat after surgery. This can cause the pannus to return.
By getting the BMI down to 30 or below before surgery, patients can minimize risks and achieve better surgical results. However, some plastic surgeons may still consider surgery for select patients with BMIs between 35-40.
Candidacy factors beyond BMI
While BMI is important, the plastic surgeon will also assess additional factors to determine if a patient is a good panniculectomy candidate, such as:
- Overall health – Medical history, diabetes, heart disease, smoking, lung disease, etc.
- Activity level and fitness – Functional mobility is important.
- Nutrition status – Well-nourished patients heal better.
- Realistic expectations – Motivation and understanding of the procedure.
- Skin quality – Degree of skin laxity and stretch.
- Hernias – Existing hernias may need repair during surgery.
The surgeon will evaluate all of these criteria together to ensure the benefits outweigh the risks for that individual patient’s situation.
Preparing for panniculectomy based on BMI
Here are some tips to prepare for a panniculectomy based on your starting BMI:
BMI below 30
If your BMI is already below 30, you are likely a good candidate for panniculectomy surgery. Be sure to:
- Maintain a stable weight – Don’t try to lose weight too quickly before surgery.
- Discuss any health issues with your surgeon.
- Stop smoking at least 6 weeks before surgery.
- Follow any other instructions from your plastic surgeon.
BMI 30-35
If you fall into the obese category with a BMI of 30-35, you may still be a candidate, but should take steps to optimize your health. Your plastic surgeon may recommend:
- Losing some weight to get closer to a BMI of 30.
- Treating any conditions like diabetes or high blood pressure.
- Stopping smoking at least 2 months before surgery.
- Building your fitness with exercise.
Getting your weight down even a few pounds can help reduce surgical risks when your BMI is in the 30-35 range.
BMI above 35
For those with a BMI above 35, most plastic surgeons will require weight loss prior to panniculectomy surgery. Recommendations may include:
- Losing weight through diet and exercise to get BMI below 35.
- Considering bariatric surgery if BMI is 40 or greater.
- Waiting 12-18 months after major weight loss before panniculectomy.
- Quitting smoking and improving fitness levels.
- Treating obesity-related health conditions.
Losing weight reduces risks and allows for better surgical outcomes. Having patience is important to stabilize your weight and get into optimal shape.
Complementary procedures
In addition to the panniculectomy itself, your plastic surgeon may recommend additional complementary procedures depending on your situation:
Hernia repair
An incisional hernia in the abdominal wall is common with a pannus. The surgeon can repair the hernia at the same time as the panniculectomy.
Belt lipectomy
A belt lipectomy extends the incision around the back to remove back rolls and lateral tissue. This provides a more circumferential lift.
Liposuction
Liposuction can be used to remove fat deposits and contour the abdomen, flanks, and hips.
Abdominoplasty
If muscle repair and tightening of the abdominal wall is needed, a full tummy tuck is combined with the panniculectomy.
Discuss all of your options with your plastic surgeon to develop the ideal surgical plan.
Recovery and results based on BMI
Patient BMI also has an impact on panniculectomy recovery and results:
BMI under 30
Patients at a healthy BMI tend to have:
- Faster recovery
- Shorter scars
- Lower complications rate
- Long lasting results
BMI 30-35
At this BMI range, recovery may involve:
- Longer healing time
- Higher complication rate
- Moderate scar length
- Some skin laxity
BMI above 35
Obese patients should expect:
- High complication risk
- Very long scars
- Poor skin retraction
- Higher risk of recurrent pannus
Lower BMI patients tend to have the best panniculectomy results and experience.
Conclusion
While there is no strict BMI cutoff, most plastic surgeons prefer patients to have a BMI below 30 before undergoing panniculectomy. Patients with BMIs in the 30-35 range may still be good candidates if they are sufficiently healthy.
For those with BMIs of 35 and above, most surgeons will recommend weight loss prior to surgery. Getting BMI into the optimal range reduces risks and leads to better surgical outcomes. However, the surgeon evaluates many factors, not just BMI, when determining candidacy.
Preparing for a panniculectomy takes planning and commitment. But removing the uncomfortable pannus can greatly improve quality of life. Work closely with your plastic surgeon and follow their recommendations to achieve your goals safely and successfully.