# Considering surgery..not WLS..and need info



## MLadyJ (Dec 12, 2007)

I am a SSBBW and have been considering having a panniculectomy (having my stomach apron removed). I am have problems with lymphedema there and the skin has become quite necrotic. Have you had this surgery or know of anyone that has? I would appreciate any info you might have..Thanks


----------



## BeautifulPoeticDisaster (Dec 12, 2007)

I don't have any information for you love, sorry. I have however thought/dreamt/fantasized about having one myself. I will be watching this thread to see if anyone has good info.​


----------



## Tina (Dec 12, 2007)

There are problems with having surgery on lymphedemic limbs, etc. I would consult with your lymphedema therapist before moving forward, and also discussing that with your surgeon and if s/he is used to working with those who have lymphedema.


----------



## Shosh (Dec 12, 2007)

MLadyJ said:


> I am a SSBBW and have been considering having a panniculectomy (having my stomach apron removed). I am have problems with lymphedema there and the skin has become quite necrotic. Have you had this surgery or know of anyone that has? I would appreciate any info you might have..Thanks



Just wondering what you mean when you say the skin has become necrotic? Necro meaning death, do you mean that the tissue in the area has died?

Lady I do not have any info to add, but I just wanted to wish you well.


----------



## saucywench (Dec 12, 2007)

There's a girl from the chat room who lives in Canada who had it done (fairly recently). She doesn't come in that often any more, but next time I see here there I will direct her to this thread. 



MLadyJ said:


> I am a SSBBW and have been considering having a panniculectomy (having my stomach apron removed). I am have problems with lymphedema there and the skin has become quite necrotic. Have you had this surgery or know of anyone that has? I would appreciate any info you might have..Thanks


----------



## moore2me (Dec 12, 2007)

MLadyJ said:


> I am a SSBBW and have been considering having a panniculectomy (having my stomach apron removed). I am have problems with lymphedema there and the skin has become quite necrotic. Have you had this surgery or know of anyone that has? I would appreciate any info you might have..Thanks



MLady, I haven't had a pannus operation myself, but I did spend a little time doing a medical journal search using PubMed at the following location:
http://www.ncbi.nlm.nih.gov/sites/entrez?db=PubMed

PubMed will give you abstracts of current medical journals. If you want a complete article, you should contact your states teaching hospital thru their medical library. Copies of articles are usually available at a small fee. You can also contact your local public library and a professional librarian may be able to assist you. I have summarized a few of the articles that were relevant to the panniculectomy you described. Unfortunately, most of the articles dealing with panniculectomies of the stomach were either associated with WLS (weight loss surgery) or another co-morbid condition (colon cancer, gyno-cancer, hernia repair) so the data in these journals reports must be judged as being somewhat biased due to the population being operated on bringing other problems into the surgery beside a pannus operation.

From the journal *Obesity Surg.* 2007 Jun;17(6):828-31 Authors - Araco, Gravante, Grimldi, etc.

*Devastating methicillin resistant Staphylococcus aureus wound infection following abdominoplasty in a prior bariatric surgery patient.* 
Dolan Park Hospital, Birmingham, UK
A 46-year-old female smoker presented 12 months after laparoscopic adjustable gastric banding, with massive weight loss and skin excess of the abdomen and flanks. She underwent abdominoplasty with muscle plication and flanks liposuction, but on the 14th postoperative day this was complicated by a methicillin-resistant Staph. aureus wound infection. Multiple surgical debridements and high doses of intravenous antibiotics were necessary for cure and to avoid further septic complications. Complete wound closure was achieved after 3 months of therapy. Concomitant risk factors for wound infection (obesity, smoking, flap construction) contributed to a rare but potentially fatal wound complication following abdominoplasty.We alert the surgeon to such postoperative infections and the necessity for a non-conservative approach.
_________________________________________________________________

From *Plast Reconstr Surg.* 2006 Jun;117(7):2191-7; discussion 2198

*Massive panniculectomy after massive weight loss*. Authors Manahan &, Shermak. 
Division of Plastic Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.

Massive weight loss, defined as loss of 50 percent of excess weight, often results in laxity and redundancy of the abdominal skin, causing disabling rashes, pain, physical limitation, back strain, and cosmetic deformity. The heavier the panniculus, the more marked the symptoms. Panniculectomy can treat these symptoms, but the approach must be customized because of complex medical and surgical histories related to obesity and the size of the panniculus. The aim of this study was to analyze a series of massive panniculectomies greater than 10 pounds following massive weight loss and to investigate the outcomes achieved. METHODS: All patients undergoing massive abdominal panniculectomy by a single plastic surgeon at an academic hospital from October of 2000 to December of 2003 were retrospectively studied. Seven men and 17 women qualified: one woman had a two-stage abdominal panniculectomy, each time with greater than 10-pound abdominal skin resections. All but one patient had gastric bypass. Average weight loss was 171 pounds, with an average maximum body mass index of 70.5 and a minimum body mass index of 43.7 (morbid obesity is defined as a body mass index greater than 40). Patient presentation was regularly complicated by abdominal scars. Abdominal panniculectomy was performed with conservative undermining. Hernias were repaired at the time of surgery. Routine prophylaxis against thromboembolism was performed. 

RESULTS: Average abdominal skin resection was 16.1 pounds, ranging from 10.3 to 49 pounds. Hernia repair was necessary in 13 patients. Additional surgery performed at the time of panniculectomy included skin reduction surgery of the back (40 percent), chest (32 percent), inner thigh (28 percent), and arm (28 percent). Blood transfusion was necessary in five of the cases (20 percent). Length of stay averaged 3 days. Complications included wounds requiring debridement, dressings, vacuum-assisted closure therapy and/or delayed primary closure (20 percent), and seroma requiring drain replacement or dressings (28 percent). Uncomplicated healing occurred in 44 percent of cases. CONCLUSION: Massive abdominal panniculectomy is challenging to plan, execute, and manage after surgery. The authors present their approach to these patients, with acceptable results.
_________________________________________________________________

From *Am J Surg*. 2007 May;193(5):567-70; discussion 570

*Post-bariatric panniculectomy: pre-panniculectomy body mass index impacts the complication profile*. Authors  Authurs, Cuadrado, Sohn, Wolcott, etc.
Madigan Army Medical Center, Tacoma, WA.

We evaluated 126 post-bariatric panniculectomies performed over a 3-year period. Perioperative and postoperative data were collected through chart review. Ninety-six percent of patients were female. Mean age of the population was 42. 

Complication rates were as follows: seroma 17%, hematoma 13%, surgical site infection (SSI) 17%, transfusion 6%, skin breakdown/necrosis 11%, and re-exploration 11%. Forty percent of patients experienced a complication. Pre-panniculectomy BMI was an independent predictor for developing a postoperative complication. Maximal reduction in BMI should be stressed to these patients in order to reduce their risk of complications following panniculectomy.
_________________________________________________________________

From *Obesity Surg*. 2000 Dec;10(6):530

*Panniculectomy adjuvant to obesity surgery*. Authors  Igwe, Stanczvk, Lee, etc.
Tri-City Regional Medical Center, Hawaiian Gardens, CA, USA 

Over the last 8 years, 2,231 bariatric operations were performed at the Center. 577 panniculectomies were done, with 428 (74.2%) concurrent with the GBP and 149 (25.8%) subsequent to the GBP. RESULTS: The redundant pannus weighed from 5 to 54.5 kg. Wound problems occured in 15.1% of panniculectomies. Transfusion was necessary in 1.9%.

_________________________________________________________________

From *J Wound Ostomy Continence Nurs*. 2003 Nov;30(6):334-41.
*Obesity, panniculitis, panniculectomy, and wound care: understanding the challenges.* Authors - Gallagher S, Gates JL.
SIZEWise Rentals, Ellis, Kan, USA.

Some patients are candidates for surgical removal of the pannus, and some are not candidates for this surgery. Occasionally cellulitis develops over the panniculus, leading to panniculitis. Panniculitis can lead to skin and wound problems; likewise, skin injury can lead to panniculitis. Additionally, in obese patients who require general surgery in the abdominal area, skin and wound complications may develop simply as a result of having a large panniculus. In this article, local wound care and preoperative and postoperative nursing care are discussed and case studies are presented.
_________________________________________________________________

From *Ann Plast Surg*. 2004 Oct;53(4):360-6; discussion 367.
*Panniculectomy as an adjuvant to bariatric surgery*. Authors - Acarturk TO, Wachtman G, Heil B, Landecker A, Courcoulas AP, Manders EK.
Division of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center Pittsburgh, PA 15261, USA.

A large hanging panniculus can cause problems such as intertrigo, chronic infection, and immobility. Many patients undergoing weight reduction surgery can benefit from panniculectomy either done concomitantly with bariatric surgery or later after significant weight reduction. Over the last 5 years we performed 123 panniculectomies on patients (34 males, 89 females; mean age 44.5 +/- 10.3 years) undergoing bariatric surgery. The panniculectomy was either done at the same time as the bariatric surgery in 21 patients or after a time period of 17 +/- 11 months in 102 patients.

Ninety-two percent of the patients had multiple comorbidities. Overall, patients who had panniculectomy simultaneously with the bariatric surgery had more complications than patients who had panniculectomy after their bariatric surgery. The wound infections were 48% versus 16% and respiratory distress was 24% versus 0%, respectively. The skin necrosis was 10% versus 6%, dehiscence was 33% versus 13%, and hematoma formation was 10% versus 2%, respectively. Overall, the patients had good outcomes, with 3 postoperative deaths in the group with panniculectomy at the same time of bariatric surgery. An interval of weight loss prior to the procedure makes this procedure safer and more effective.


----------



## Butterbelly (Jan 5, 2008)

My older sister had this done a few years ago. The one thing her doctors told her is that she cannot, under any circumstances, gain weight back. They explained to her, and us (the family) that when the extra tissue is removed and the swelling goes down, that the muscles tighten. The more weight she would put on, the more added pressure to those stomach muscles and, thus, she would end up with some serious stomach problems.

She didn't listen to her doctors and about a year after the surgery she had put on 30lbs. After two years she'd doubled the 30lbs and the following year, she ended up having emergency surgery because the muscles had weakened with the stretch of her stomach and she had major hernias that caused bowel obstructions. 

Even now, she has to constantly wear an ace-wrap around her stomach, because she continually gets hernias with her added weight gain.


----------



## MLadyJ (Jan 14, 2008)

Saucy..thanks sooo much..Stacie contacted me and I got alot of information from her. I have scheduled the surgery for 29 January and am now holding my breath..hoping not to run into anyone with the flu..etc. From everything the Dr. has told me this "should be " a fairly easy ( as easy as surgery on a SSBBW can be) recovery as there will be no muscle cutting. I'll let you know how it comes out.. Thanks everyone for your input and kind words..


----------



## Pilgrim060 (Mar 4, 2008)

I am looking for a person or a group to talk to about my pending Panniculectomy surgery. I am hoping to find someone who has had my issues. I am 71 years old, have Lymphedema, Diabetes and am heavily overweight. With all my issues I haven't been able to lose weight.
The Lymphodema has caused my abdomen to hang down. It contains flesh and fluid as well as skin. The Panniculectomy would remove about 65 pounds. If any of you have had some or all of these issues I would love to hear about your experience. 
[email protected]


----------



## MLadyJ (Mar 12, 2008)

Thanks everyone for your support and good wishes. I had my surgery on 29 Jan and except for being violently ill from the anesthetic I came through in great shape. The Dr. was wonderful. My pannus weighed a whopping 49+ pounds and the Dr. said there was ALOT of fluid loss besides the portion they removed. Laughing..he said I was a "juicy one". I haven't had pain meds since day 10 and am healing well. I have a couple of spots that are slower healing but all in all I was really pleased. I don't think this type of surgery is for everyone but for me it has allowed me to move much more freely and I do have more stamina than before..again..thanks to you for you support.


----------



## Fairest Epic (Mar 12, 2008)

MLadyJ said:


> Thanks everyone for your support and good wishes. I had my surgery on 29 Jan and except for being violently ill from the anesthetic I came through in great shape. The Dr. was wonderful. My pannus weighed a whopping 49+ pounds and the Dr. said there was ALOT of fluid loss besides the portion they removed. Laughing..he said I was a "juicy one". I haven't had pain meds since day 10 and am healing well. I have a couple of spots that are slower healing but all in all I was really pleased. I don't think this type of surgery is for everyone but for me it has allowed me to move much more freely and I do have more stamina than before..again..thanks to you for you support.



yay! 
I am not familiar with the majority of terms of this thread, but i am glad to see that you pulled through and that you are happy with your decision!
go you for being a strong woman!


----------



## Miss Vickie (Mar 12, 2008)

MLadyJ said:


> Thanks everyone for your support and good wishes. I had my surgery on 29 Jan and except for being violently ill from the anesthetic I came through in great shape. The Dr. was wonderful. My pannus weighed a whopping 49+ pounds and the Dr. said there was ALOT of fluid loss besides the portion they removed. Laughing..he said I was a "juicy one". I haven't had pain meds since day 10 and am healing well. I have a couple of spots that are slower healing but all in all I was really pleased. I don't think this type of surgery is for everyone but for me it has allowed me to move much more freely and I do have more stamina than before..again..thanks to you for you support.



I'm so glad to hear it went really well and that you're feeling lots better. Good for you!


----------



## moore2me (Mar 12, 2008)

MLadyJ, Wow - 49 lbs of skin removed from your pannus area is something! I bet you do feel better without the stuff. I hope you continue to heal well. I assume they are getting you ambulatory and teaching you to walk again without the burden of that excess flesh messing with your center of gravity. Good luck and good wishes on your futher recovery. Keep us informed. 

View attachment 707798.jpg


----------

