التعريف والنظرة العامة
An infraumbilical panniculectomy is the excision of excessive skin and subcutaneous tissue in the abdomen. It can be combined with lipectomy, which is the surgical removal of fatty tissue from different body parts, including the abdomen, to achieve better cosmetic results.
An infraumbilical panniculectomy with lipectomy is performed to remove the overhang of skin and subcutaneous fat that commonly appears in the lower abdominal area, which is called the panniculus. The procedure often becomes necessary for overweight or obese patients.
A panniculectomy can be performed either for medical or cosmetic reasons. There are some criteria that have to be met for it to be considered medical in nature. Unless such criteria are met, the procedure is deemed cosmetic.
من يجب أن يخضع للنتائج المتوقعة
An infraumbilical panniculectomy with lipectomy is a medically necessary procedure for obese and overweight patients with a panniculus. These patients typically present with the following symptoms in their lower abdominal area:
- Excess skin
- Stretch marks
- Open wounds below the skin folds
Patients who have a panniculus may find it difficult to maintain good hygiene in the lower abdominal area. The excess skin can also interfere with movements in severe cases.
An infraumbilical panniculectomy becomes medically necessary if the following conditions are met:
- The panniculus hangs up to or even below the pubic symphysis
- The patient has lost weight but still suffers from a panniculus for at least one year
- The panniculus impairs movements or hinders the patient from having a normal life
- The panniculus causes complications that do not respond to treatment within six months, such as:
- Tissue necrosis
- Chronic intertrigo
- Exfoliative dermatitis
- Febrile neutrophilic dermatosis
- Other erythematous conditions
A panniculus is also medically removed if it deforms the abdominal region. The degree of deformity is graded based on the size of this “apron of skin”.
- Grade 1 – The panniculus reaches the pubic hairline but not the genitals.
- Grade 2 – The panniculus covers the genitals.
- Grade 3 – The panniculus covers the upper thigh.
- Grade 4 – The panniculus covers the middle thigh.
- Grade 5 – The panniculus reaches down to the knees (or even below).
On the other hand, infraumbilical panniculectomy with lipectomy is considered cosmetic in nature when combined with any of the following procedures:
- Abdominoplasty – A surgical procedure used to remove excess fat and skin from the abdominal area.
- Umbilical transposition – A surgical procedure that improves the appearance of the belly button.
- Fascial plication – A procedure that tightens the abdominal muscles.
A panniculectomy is also not medically necessary if it is used only to:
- Relieve neck and ألم في الظهر caused by spinal stress
- Improve a patient’s post-pregnancy body after childbirth
كيف يتم إجراء العملية؟
A surgeon performs an infraumbilical panniculectomy with lipectomy with the following steps:
- The patient is placed under general anaesthesia.
- The surgeon makes a hipbone-to-hipbone incision above the pubic area.
- The surgeon then removes a wedge of excess skin and subcutaneous tissue. In a basic panniculectomy, the surgeon is not concerned about the appearance of the abdomen. This means that the abdominal muscles and the belly button are left untouched.
- The patient will be asked to stay in the hospital overnight. Pain can be managed with oral pain medications.
- The doctor will check on the patient the day after the procedure. During this initial post-operative checkup, the dressing on the wound is changed. The wound is also checked for signs of severe bleeding or fluid collection.
- If the surgeon had placed drains on the wound, the patient is asked to go back a week after to have them removed.
The whole procedure can take anywhere from two to five hours depending on the severity of the patient’s condition. It can be performed alone or in combination with other procedures that can improve the appearance of the abdominal area.
In a cosmetic panniculectomy, the surgeon may also perform surgery on the abdominal muscles, which are often widened due to the excess weight and tissue of the panniculus. The surgeon may even relocate the belly button. If these procedures are performed, the surgery is closer to an abdominoplasty rather than a panniculectomy.
المخاطر والمضاعفات المحتملة
Patients who undergo an infraumbilical panniculectomy are at risk of:
- Blood clot
- Injury to the blood vessels and nerves
- Injury to the surrounding structures
- Poor cosmetic result
- Deep venous thromboembolism
- Pulmonary embolism
- Fluid buildup
- Allergic reaction to anaesthesia
In some cases, the patient may require a revision surgery.
Salunke AA, Rajkumar KS, Nambi GI, Chaudhari VA. “Massive panniculectomy: A novel method of treatment of postlaparotomy wound dehiscence in morbid obesity.” Can J Surg. 2014 Apr; 57(2): E53-E54.
Micha JP, Rettenmaier MA, Francis L, Willenberg R, Brown JV. “Medically necessary panniculectomy to facilitate gynecologic cancer surgery in morbidly obese patients.” Journal of Pelvic Surgery. 1999 January; 5(1): 61.
**What is Infraumbilical Panniculectomy with Lipectomy: Overview, Benefits, and Expected Results**
* Infraumbilical panniculectomy with lipectomy is often referred to as a “mommy makeover” as it is commonly sought after pregnancies.
* Targeted towards patients with excess sagging skin and fat that hangs below the belly button.
* Encompasses the surgical excision of redundant skin and fat below the abdomen.
* Can be combined with additional procedures such as abdominoplasty or liposuction to simultaneously address excess skin and stubborn bulges.
* Provides significant aesthetic improvement by removing unsightly skin and revealing a smoother, tighter abdomen.
* Reduces risk of skin infections and rashes caused by excessive folds of skin.
* Can potentially alleviates lower back pain or discomfort caused by the excess weight.
* May improve hygiene by reducing moisture retention and facilitating ease of bathing and cleaning.
* Enhances self-confidence and body image.
* Reduced hanging skin and improved contour in the abdominal area.
* Flatter, tighter abdomen.
* Reduced skin folds.
* Improved posture and overall body proportions.
**How to Determine Candidacy**
* Ideal candidates possess sufficient skin elasticity to accomodate the re-draping and tightening procedure.
* Must be in good overall health, have stable weight, and maintain realistic expectations.
* Frequently sought after by post-partum women, those with significant weight loss, or individuals battling loose skin due to genetics.
**Preparation and Procedure**
* Pre-surgical consultation involves assessment of medical history, performing physical examination, and discussing patient goals.
* Pre-operative instructions include maintaining a balanced diet, ceasing smoking and alcohol consumption, and managing medications as guided by the surgeon.
* Procedure typically takes around two to three hours under general anesthesia.
* Extensive incision is made along the abdomen, just above the pubic area, to allow the surgeon to access and remove excess skin and fat.
* Underlying abdominal muscles may be tightened during the operation as well.
* Surgical drains are often placed to prevent fluid build-up.
* Patients may experience some discomfort, swelling, and bruising for several weeks.
* Post-operative care involves proper wound care, wearing compression garments as prescribed, and elevating the legs to reduce swelling.
* Strenuous activities and heavy lifting should be avoided during the healing period.
* Recovering can take several weeks, necessitating follow-up appointments for monitoring and suture removal.
Infraumbilical panniculectomy with lipectomy presents a comprehensive solution for eliminating excess hanging skin and fats from the lower abdomen, resulting in a more aesthetically pleasing and functional outcome. It offers remarkable outcomes in terms of enhancing body image and improving overall quality of life.