I have a large pancake flap, around 30 pounds. Is it possible to have that much fat removed? (Photo)

Am I able to have that much day removed, and pay out of pocket? Or am I required to have a doctors referral? I just want my abdominal fat removed. Is that possible?

Doctor Answers 5

Cosmetic Surgery does not equal weight loss

Thank you for your question; I think it is a really great one and one that many people have.  I have performed literally thousands of surgeries for "fat removal."  Whether you are considering liposuction or a tummy-tuck, both involve fat removal and you can certainly undergo one, or both of those procedures.  Ideally, patients considering this type of surgery should be at or near their healthy normal weight.  Despite this, most surgeons have made exceptions and performed these surgeries on people who are overweight and not the "ideal" candidate.  I tell 100% of my patients that "liposuction does not equal weight loss."  Regardless of how much fat is removed, if your lifestyle remains unchanged with respect to diet and exercise, you will put that weight back on.  It may not go the same body area where you had the procedure done, but it will go somewhere.  Therefore, ideally, you should do your best to lose weight through diet and exercise (especially diet) and then turn to cosmetic surgery for those trouble spots or loose skin.  Most states have a legal limit on how much fat can be removed as an office-based, outpatient procedure and that will limit how much can be removed at one procedure.  Also, it is often not possible (or advisable) to remove close to 100% of the fat layer; that is how you can end up botched with unnatural dimples, grooves, and divots.

If you were my patient, I would discuss our weight loss program with you and encourage you to pursue that first.  In select "non-ideal" individuals with realistic expectations regarding the limitations of liposuction, I have performed liposuction and they have been satisfied.  For example, I had a patient with a BMI of 41 (she weighed nearly 300 lbs) and she wanted liposuction of her upper arms, because she had such a hard time finding tops that her arms could fit into.  After a rather lengthy discussion about the limitations of liposuction and the need for a lifestyle change and weight loss, I did perform the procedure on the upper arms and she was very happy with the results.  Her goal was not to look thinner, but to fit into her clothes better and that was a goal I could help her realize.  Conversely, another patient of mine, about the same size in her late thirties, came in for a liposuction consult and I gave her the same long discussion about weight loss, etc.  I performed liposuction of the abdomen and removed 5 liters (the legal limit in my state) of pure fat (that's 10 lbs) just from her abdomen.  She was already disappointed and complaining about the fact that she still looked fat as we were wheeling her out to her car and she continued to complain loudly for some time thereafter.  If one is obese, even taking 10 lbs of fat out, will not make them look thin.  In this patient, it absolutely made her abdomen much smaller, but she still was not satisfied, because she simply did not hear anything she was told during her consultation and pictured herself thin.  The most important thing is to have realistic expectations and discuss those expectations with your surgeon and make sure you and s/he are on the same page.  To answer your question regarding payment: almost all cosmetic surgery in the USA is out-of-pocket and not reimbursed by health insurance.  Sorry for the lengthy answer - I hope others will wade through it, because nearly every day I see someone with this question and the answer is always long and involves me talking a lot about the limitations of these procedures in those with a BMI over 32.  Nevertheless, I still end up performing many procedures on less-than-ideal patients and the vast majority of them are very satisfied with their results.

Removal of Abdominal "Pancake Flap"

It is possible to have that much fat removed, but can it be done SAFELY? That should be the first question and is the most important question, more so than how the procedure is paid for. Can it be done? Yes, the extra skin and fat can be cut off. That's not the most difficult aspect of what you're seeking. It's not even the closure or sewing together of your thick layers after the skin and fat is cut off that would be the most difficult aspect. The most difficult aspect would be your ability to heal. The thickness of the flaps makes it highly unlikely to heal. This would leave you with an open wound which would take months and months to heal. So is it possible? Yes. Should it be done? No, not at this time. Liposuction is also not an ideal solution as all the dead space left from removing that volume of fat would lead to fluid pockets known as serums where the fat used to be and possible worsening of your hanging skin.

But don't despair. Removal of your flap can be done with the right planning. First, it's best to get your weight down to a reasonable weight for your height. A BMI of less than 30 will put you at less risk for major surgical and anesthesia complications. As you lose weight, the flap will get thinner and healing will progress more easily after surgery, making it a safer procedure for you. After all, that's what's most important! Consult with your primary care doctor for weight loss solutions, e.g. improved nutrition and exercise alone or in conjunction with bariatric surgery. 

Best of luck!


Millicent Odunze-Geers, MD, MPH
Sacramento Physician
4.6 out of 5 stars 5 reviews

Vaser Liposuction/ Liposculpture / Hi Definition procedures/Body Contouring with fat grafting

Thank you for your question.

Best to be at a BMI less than 30 or within 10 pounds of your goal weight and stable at that weight for 6 months prior to surgery for optimal results.

The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative plastic surgery.

Dr. Schwartz
Board Certified Plastic Surgeon
Director-Beverly Hills Breast and Body Institute
#RealSelf100Surgeon


You CANNOT have SAFE Liposuction removal of a 30 pound overhang

You CANNOT have a safe removal of a 30 pound overhang. The most one remove in an outpatient setting is about 10 pounds of fat. Removing more would require overnight or longer hospitalization and IV fluid resuscitation.
But, EVEN IF, such amount of fat was removable, it would leave you with a very deflated, overhanging loose skin which would not be appealing.
The best way to improve on this is either to lose weight by yourself OR have bariatric surgery. For good results your BMI should be 27 or lower. The outcomes will be vastly superior to doing anything now.

Peter Aldea MD
Memphis, TN

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 102 reviews

Liposuction or Tummy Tuck Candidate

You need to have weight loss prior to having a safe procedure.  I suggest seeing a doctor that does both fat reduction and skin removal but this should be done after setting up a weight loss program.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.