I'm 268 pounds, 5' 7" with a BMI of 42, would I be a panniculectomy candidate? (Photos)

Question

I had weight loss surgery (vertical Sleeve) I had 3 c-sections I lost a 130 pounds from surgery. Would I be A good candidate for a panniculectomy to me lower stomach skin removal an fat (Referred to as an apron) I have a large sagging hanging stomach which causes infection rashes . And also affects my hygiene which is very embarrassing. I can't do daily activities with my kids or just for myself. I have lost a lot of weight and still feel trap I am healthy I have no medical issues.

Babak Moeinolmolki, MD, FACS · Answer

Hello,
Thank you for your question and congratulations on your tremendous weight loss! It is challenging in situations such as yours to determine optimal timing for skin removal. Insurance generally covers panniculectomy for patients like you, when the pannus falls to the level of the pubis (pubic bone) and rashes are difficult to manage even with topical treatments (i.e. creams). 
You do not mention how long it has been since your weight loss surgery. It’s important that you weight be stable prior to a panniculectomy or tummy tuck. Typical this occurs 12-18 months after surgery. The pros and cons of a panniculectomy alone vs panniculectomy with tummy tuck should be discussed at length. Oftentimes my patients will undergo combined panniculectomy and tummy tuck, covering the out of pocket portion not covered by insurance. 
As a combined bariatric (obesity) and cosmetic surgeon, performing skin removal and body lifts that allow my patients to strengthen and maintain their healthy lifestyle changes is one of the most rewarding aspects of my job.
Video or in-person consultation with a cosmetic surgeon will give you a better understanding of the surgical options and best timing for your needs.
Best wishes,
Dr. Moein

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question and for sharing your photos and history. Based on your photos and your history of weight loss, you seem like an excellent candidate for a panniculectomy or, even better, a tummy tuck.

A panniculectomy would remove the excess skin and fat (the "apron") that’s causing rashes and hygiene issues. This would help improve your comfort and ability to perform daily activities. However, a panniculectomy is primarily focused on functional improvements and doesn’t include muscle repair or provide the same degree of body contouring.

A tummy tuck (abdominoplasty), on the other hand, would not only remove the excess skin but also tighten the abdominal muscles and improve the overall shape of your midsection. This would give you better long-term results both functionally and aesthetically. Since you’ve already had weight loss surgery and lost a significant amount of weight, a tummy tuck could help you feel even more confident and comfortable in your body.

I recommend discussing both options with your plastic surgeon, especially since the rashes and hygiene issues could help qualify you for insurance coverage of a panniculectomy.

Sincerely,
Dr. Katzen

Kenneth Hughes, MD · Answer

With a current BMI of 42, you would benefit from discussing an exercise and diet program with your PCP.  Your PCP could also prescribe something for your rashes.  Once you reach a BMI of about 30, you would be a good candidate for a TT, which because it is a cosmetic procedure, would not be covered by your medical insurance.  A panniculectomy only involves removal of the hanging tissue to address hygiene issues, rashes/infections, etc.  It does not involve the extent of tissue undermining, tissue removal or plication needed after 3 C-sections or umbilical transposition.Check with your medical insurance provider to determine if you meet specific criteria for them to cover the panniculectomy.

Dallas Buchanan, MD · Answer

Thank you for your questions. Congrats on your weight loss. It would seem that you have a medical indication to have the skin removed seeing as how it alters your day to day functions. The problem is convincing an insurance company of that and finding a surgeon who is willing to take insurance payment for the procedure. Insurances are notoriously hard to convince of medical necessity for this procedure and even when they do, the amount they are willing to reimburse surgeons to perform it is atrocious, so most surgeons elect not to take on this burden.Best of luck to you!Dallas R. Buchanan, MD, FACSOwner & Board-Certified Plastic SurgeonVIVIFY plastic surgery

Robert L. Kraft, MD, FACS · Answer

Your BMI is still very high. If you are still losing weight, surgery should be deferred until you have reached a stable point.  In the meantime, see a dermatologist for treatment of the rashes.  If conservative treatment is documented, the panniculectomy may ultimately be covered by insurance.

Leonard Tachmes, MD · Answer

Hi and welcome to our forum!
From the standpoint of function, I can see why the pannus interferes with your activities of daily living. A panniculectomy is designed to remove the hanging tissue with limited or no undermining to preserve the blood supply to the tissues. It is much simpler than abdominoplasty and as a result there are less complications.  From the standpoint of patient safety, your BMI of 42 does increase your operative risk. It is difficult, but try to lose some weight prior to your procedure.
Seek a consultation with a board certified plastic surgeon.
Best wishes...

I'm 268 pounds, 5' 7" with a BMI of 42, would I be a panniculectomy candidate? (Photos)

Answers (6)

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