Panniculectomy (Abdominal Apron Resection)

What Is an Abdominal Apron?

An abdominal apron is an excess flap of the skin characterized by sagging, drooping skin in the abdominal area. Suppose there is rapid weight loss due to severe obesity. In that case, there is a risk of developing an abdominal apron because the skin and connective tissue adapt to additional weight over time and weight gain is often steady and slow. If a patient now loses weight relatively quickly, there is an increased risk of developing such an abdominal apron.

Nevertheless, an excess skin flap can develop even in patients with less weight loss because each patient has a different genetic predisposition and differently structured connective tissue. In addition, the resulting skin fold underneath the skin flap can lead to problems in the long term because fungal infections and skin irritations can occur within the skin fold due to heat and perspiration.

How Does an Abdominal Apron Develop?

The most common reason for developing an abdominal apron is the rapid loss of weight and a lot of weight loss in severe obesity.

Some patients have connective tissue weakness, which promotes the development of an abdominal apron. Another reason for developing an abdominal apron can be pregnancy, especially after multiples. But age-related skin and connective tissue changes are described as a cause.

How to Get Rid of an Abdominal Apron?

Getting rid of an abdominal apron is not an easy process. However, patients feel justifiably proud of their success after effective weight loss. Still, frustration often ensues when sagging skin flaps form and do not disappear due to the weight loss program. In addition, a large excess skin flap can also be a hindrance to any exercise or sport.

Depending on how large the fat flap is, a special exercise and diet program can help in some cases. However, in most cases, the disappearance of the skin flap proves difficult with sports alone because although exercising builds up muscles, which also tighten the connective tissue, a pronounced excess of skin cannot be "trained away" independently. Then surgery is an option, which removes the skin flap and the excess tissue.

Abdominal Apron Removal Through Sports

The first step is strengthening the abdominal muscles and losing additional weight through regular fitness, endurance sports, and weight training. A balanced diet plan is also important in this process. However, the options are limited depending on the extent. Especially with weakened connective tissue and plenty of excess skin after severe weight loss, the abdominal apron cannot be "trained away" by fitness alone.

Abdominal Apron Removal by Surgery

Surgery should be considered if the skin flap cannot be treated with an exercise program. In addition, the patient finds the abdominal apron disturbing, psychologically stressful, or even restrictive to health.

The surgery is called abdominoplasty, or tummy tuck, and involves a transverse abdominal incision above the pubic area. In this way, the scars subsequently disappear inside the pubic area. Skin and fatty tissue are detached from the abdominal muscles, and excess tissue is removed. It may be necessary to cut around the belly button to move it afterward. The skin is tightened, and the wound edges are then sutured. In some cases, additional liposuction or a combination of removal of skin and fatty tissue from other parts of the body may also be considered.

Procedure and Duration

Before the procedure, the skin fold and all the essential landmarks are precisely measured, and the edges of the incision are recorded so that the surgeons can draw up a plan beforehand. The procedure takes about one and a half to four hours and is performed under general anesthesia. Afterward, drains are left in the wound area for a few days to drain the wound water, later removed. The inpatient stay is about three days, but the healing process and rest require significantly more time. In addition, patients must wear an abdominal belt after the procedure to aid in wound healing and relieve tension from the sutures. Likewise, the belt minimizes the risk of postoperative bleeding.

Risks and Healing Process

Any surgical procedure can involve risks. These include wound healing problems, inflammation, and intraoperative and postoperative bleeding. In addition, in exceptional cases, patients with a corresponding predisposition may experience increased scarring.

The healing process takes about two to three weeks, and patients should take it easy for the first few weeks, particularly avoiding traction and tension on the wound edges and sutures. It takes about six weeks before the patient has reached full physical strength back. The scars fade after about six to eight months.

Costs for a Panniculectomy

The surgical costs vary between three thousand and eight thousand euros. The price depends on the extent of the procedure. Health insurance does not cover the costs in most cases, but it is possible to apply for coverage. However, this is only accepted in exceptional circumstances if the patient can prove with the help of an expert opinion that the abdominal apron has health consequences. Typically, patients must cover the costs themselves.

Sources:

• https://www.ukbonn.de/plastische-und-aesthetische-chirurgie/behandlungsspektrum/aesthetische-chirurgie/koerperchirurgie/abdominoplastik-bauchdeckenstraffung/
• https://www.moser-kliniken.de/de/schoenheitsoperationen/hautstraffung/fettschuerze-entfernen
• Kurzlehrbuch Chirurgie. Schumpelick V, Bleese N, Mommsen P, Hrsg. 8. vollständig überarbeitete und erweiterte Auflage. Stuttgart: Thieme; 2010. doi:10.1055/b-002-33687
• Adipositas - Ursachen, Folgeerkrankungen, Therapie 02/2019