Maximizing the aesthetic result in panniculectomy after massive weight loss

Plastic surgical consultation for abdominal contouring following massive weight loss is becoming increasingly prevalent, especially with the popularity of surgical weight loss procedures. The authors reviewed their experience with a novel panniculectomy technique that generally combines horizontal and vertical tissue excision to generate the best contour possible while providing effective relief of symptoms related to a dependent abdominal panniculus.

A retrospective chart review was conducted of 100 consecutive patients who underwent panniculectomy using the authors' technique over a 5-year period. Demographic and procedural data were collected, and outcome measures were analyzed.

Eighty-seven women and 13 men with an average weight loss of 133 lb underwent abdominal panniculectomy. A total of 37 ventral hernias were repaired concomitantly. Mean clinical follow-up was 16 months. Hospital length of stay averaged 4 days, and the most common complications were blood transfusion requirement (n = 39), fluid collections (n = 32), tissue necrosis requiring debridement (n = 18), and contour irregularities requiring revision (n = 15). Overall, 56 patients had a completely uncomplicated recovery. Greater amounts of tissue resection were associated with higher rates of transfusion (p < 0.01).

The panniculectomy technique described can be performed safely and reproducibly. It yields an excellent abdominal contour and is effective in alleviating many symptoms of the dependent abdominal panniculus. It also provides exposure for improved evaluation and repair of concomitant ventral hernia defects.