I've lost 50 lbs. If I have a panniculectomy soon, could I have a second panniculectomy when I lose 50 more pounds?

Question

I'm 73 years old & healthy. I weighed 200+ pounds for ~25 years, but after 2 knee replacements and 2 lumbar rhizotomies, I can exercise! Eating less & walking 2 miles/day, I've easily lost a pound a week for a year, from 230 to 180. Goal 130. Prolapsed vagina means possible hysterectomy, through the abdominal wall due to adhesions. I hope for hysterectomy + panniculectomy. If I develop another big pannus, could a 2nd panniculectomy be done, or should I wait until I get down to 130 pounds?

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question, and congratulations on your weight loss! You’re doing a fantastic job with your health journey. Regarding your question, while it is possible to have a panniculectomy now and potentially a second one after you lose another 50 pounds, it’s generally recommended that you lose as much weight as you can before undergoing a procedure like a panniculectomy or tummy tuck. This will give you the best possible results.

Even if you experience a plateau after losing an additional 20 or 30 pounds, you may find that you won’t need a second procedure. Reaching a more stable weight allows the surgeon to remove the appropriate amount of excess skin and fat in one surgery, rather than needing to address changes in your body after further weight loss.

A tummy tuck could be an even better option once you’ve reached your goal weight or close to it, as it would not only remove the excess skin but also tighten the abdominal muscles and provide a more defined, aesthetic result.

If you’re eager to proceed with the panniculectomy now, it is possible, but waiting until you’re closer to your goal weight could reduce the likelihood of needing another procedure in the future.

Sincerely,
Dr. Katzen

Justin Gusching, DO · Answer

You could for sure have a panniculectomy at this point in your weight-loss journey but I would recommend waiting until you get down to the 130 lbs. 180 to 130 is quiet and change and at the rate your going, the 130 should be obtainable without too much issues. This will allow for a better panniculectomy as there won't be as much scar tissue buildup. As with any, there is a lot of grey area and having a panniculectomy is fine pending you understand what you are having and what may happen in the future with weight-loss.

Kenneth Hughes, MD · Answer

If you get the panniculectomy too early, then you may still lose weight after that surgery and you may experience more excess skin. In that case, you may have to go back and have a second panniculectomy or tummy tuck. Wait until you reach your weight goal.

Camille Cash, MD · Answer

Congratulations on your impressive weight loss and commitment to your health!  It is best to wait until you have reached your goal weight before proceeding with surgery.  This will allow your surgeon to maximize your results.  For a second surgery you would have to develop a pannus that once again met criteria to deem it medically necessary for removal.

David S. Rosenberg, MD · Answer

insurance is unlikely to pay for 2 panniculectomies.  If you are willing to pay for one of them out-of-pocket then yes you can have 2.

Andrew Friedman, MD · Answer

Difficult to give you a good answer without seeing you or your pictures. I like to have my patients loose all the weight they can before doing surgery, so we can do it once. A panniculectomy can be repeated, but goal is to not.

I've lost 50 lbs. If I have a panniculectomy soon, could I have a second panniculectomy when I lose 50 more pounds?

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