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What is Pannus? Understanding the Causes, Symptoms, and Treatments

Editorial Team
Updated Mar 03, 2024
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Understanding what a pannus is can be crucial for individuals dealing with significant weight fluctuations. A pannus, or panniculus, often manifests as an abdominal apron of excess skin, fat, and tissue that hangs at the bottom of the abdomen. This condition is not uncommon; for instance, the American Society of Plastic Surgeons reported that in 2020, around 57,000 panniculectomy procedures were performed to remove this excess tissue. Pannus typically affects those who are overweight or morbidly obese, as well as individuals who have experienced substantial weight loss and are left with lingering skin. For those seeking relief and improved quality of life, a panniculectomy offers a surgical solution, tailored to address the physical discomfort and potential health issues associated with a pannus.

An excessively large pannus causes back strain. Obese patients might have difficulty moving around because the tissue hangs down over their knees or between their legs. It can also be difficult for patients to adequately wash all parts of the body, and they might have an unpleasant odor because of a buildup of sweat and moisture. Some people develop heat rashes, skin tags and skin ulcers from the constant dampness.

Medical professionals can treat the problem by performing an abdominal panniculectomy, which is a surgical procedure that removes the excess tissue and fat from the area. The operation might be covered by health insurance if the pannus descends past the groin or causes medical problems, such as skin infections and back pain. Insurance companies might not pay for the procedure if it is performed strictly for aesthetic purposes.

Severely overweight people who undergo panniculectomies are at risk of developing infection because of the depth of the cuts and the amount of tissue that is removed. Many healthcare professionals and insurance agencies require patients to lose weight before they will perform the operation, and patients should maintain a stable weight for at least one year before surgery to show that they will not need to operation again in a few years.

A panniculectomy is a serious operation that takes several hours to complete. A qualified cosmetic surgeon can perform the procedure either in an outpatient surgery center or in a hospital. Patients are anesthetized during the operation and usually spend several days recovering in the hospital afterward.

The surgeon performs a vertical incision from the breastbone to the pubic bone, followed by a second horizontal cut near the pubic area. He removes the fat and tissue, sutures the patient and installs temporary drainage tubes to remove any excess fluid that builds up inside the abdomen. He also will send the patient home with post-operative care instructions as well as prescription medications for the pain and swelling.

A panniculectomy will usually make patients more comfortable and improve their mobility, but the surgery is not risk-free. Individuals might experience bleeding, infections, blood clots and excess fluid buildup. It also leaves scars on the abdomen.

Panniculus vs Pannus

Despite the popular belief that the pannus and the panniculus are the same things, the two are actually two different things. Pannus is a medical term that refers to layers of fibrovascular tissue or granulation tissue that are abnormal. A pannus may grow in a tumor-like fashion, such as over a joint surface in a patient who has rheumatoid arthritis. When this happens, the pannus can erode the patient's bone and cartilage. Other common places where a pannus may grow include on a prosthetic heart valve or over the cornea.

Many people call the fatty tissue in the lower abdominal area a pannus, but the reality is that it is called a panniculus. This medical term refers to the dense layer of fatty tissue that contains subcutaneous fat and is often the result of obesity. It may also be noticeable after a pregnancy or after someone loses a large amount of weight. Sometimes, a panniculus is mistaken for a hernia or tumor, but the reality is that it's the result of loose tissue.

How To Get Rid of Pannus

Getting rid of a pannus (not a panniculus) depends on where it is. One of the most common types of pannus is the one that causes inflammation for rheumatoid arthritis patients, for example. An RA patient who has pannus-related inflammation can make some changes at home to relieve some of the symptoms.

  • Changing the Diet – Eating more fiber, fruits, and vegetables can relieve the symptoms of pannus inflammation. It is also a good idea to avoid too many carbs or foods that are high in sugar or caffeine content.
  • Exercising Regularly – When RA patients do not move enough, the joints become stiff and inflamed. RA pannus makes that inflammation worse. RA patients should exercise several times a week to reduce symptoms.
  • Quitting Smoking – Smoking, including vaping, exposes the body to toxins that can trigger pannus inflammation and cause pain for RA patients.
  • Reducing Stress – Stress is everywhere, but it is important for RA patients to do what they can to relieve the stress, such as meditation, music, or spending time with loved ones or pets.
  • Sleeping More – Insomnia leads to a reduction in the body's ability to keep infections and inflammation at bay. RA patients who sleep 8-10 hours per night are less likely to deal with pannus-related pain than other patients are.

Many people mistakenly search for "pannus removal" when they mean "panniculus removal," which can lead to misinformation. Read on to learn about panniculus removal.

How To Get Rid of the Panniculus

A panniculus can develop for a number of reasons. Typically, it occurs because someone gains weight and then loses it rapidly, such as what happens after someone has bariatric surgery. Other times, someone develops a panniculus after a pregnancy. Regardless of why you have the excess fatty tissue on your lower abdomen, there are several things you can do to combat the problem and feel more comfortable in your skin.

Exercise Regularly

As you lose weight, you'll need to start doing what you can to target specific parts of your body. If your lower abdomen develops a panniculus, which you may also hear referred to as an "apron belly," you'll need to do specific exercises. To start lifting the abdomen, add sit-ups or crunches to your workout routine. Swimming, walking, and lifting weights can also help you to tone the area and lessen its appearance.

Nonsurgical Procedures

If your panniculus is at least one inch of fat but not much more than that, you might be a good candidate for a cryolipolysis procedure. Cryolipolysis uses targeted lasers to freeze and eliminate the fat cells that cause the panniculus. This treatment may not be an option for people who have more than an inch of fat left in the lower abdomen, so additional weight loss may be required. Typically, results can take up to 6 months to appear but are lasting results once they do become apparent. Cryolipolysis does not require any surgical cuts and has very few complications. Fewer than 1% of people report any complications, and those that did had minor ones, such as redness and mild swelling.

Surgical Procedures

Some people have enough excess skin and fat cells after large weight loss that their doctors recommend a panniculectomy. A panniculectomy removes the excess skin that covers the genitals and upper legs. Because it is a surgical procedure, candidates must meet certain requirements, especially if they want their insurance providers to pay for it. Good candidates do not have uncontrolled cardiac or lung diseases, do not have uncontrolled diabetes, and are nonsmokers. Weight must be stable for at least six months and must be in good health. Most insurance providers require the abdominal apron to interfere with daily activity in order to pay for it.

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Editorial Team
By Editorial Team
Our Editorial Team, made up of seasoned professionals, prioritizes accuracy and quality in every piece of content. With years of experience in journalism and publishing, we work diligently to deliver reliable and well-researched content to our readers.
Discussion Comments
By anon992759 — On Sep 29, 2015

I am a male with a stage 6 pannus that weighs almost 100 pounds. I have lost 300 pounds from 670 down to about 380. We have rigged up a "pannus carriage" for me; kind of like a walker (which I was using anyway since my knees are severely damaged) with a height-adjustable platform. It helps with exercise (simply walking around, which was an incredible struggle before) since I am now no longer trying to lift and push the almost 100-pound belly with every step that hangs to almost my knees.

Surgery is scary, and I would have to lose another 100-150 pounds. Hopefully some of it would be from the omnipresent pannus, which I have to handle with care since it's prone to skin tears with any kind of dropping or falling events, along with incredible pain. I'm still dreaming of being able to have sex again, fit behind a car steering wheel again, and an end to bizarre toilet adventures, although the pannus platform helps with some of that too. It will be wonderful when it is not the major topic of all mobility movement in my extreme morbid obesity damaged life.

By anon327834 — On Mar 31, 2013

Can a 74-year-old woman with heart problems and history of stroke survive this surgery to remove the pannus? Would any surgeon touch her? She can barely move after recovering from a broken ankle. It is painfully obvious that after weeks of sitting (non-weight-bearing orders for recovery of ankle) that she is so weak and hauling her pannus around is becoming next to impossible. She's in physical therapy daily, but I'm wondering if getting rid of this weight will help her walk again eventually. Any thoughts?

By anon309924 — On Dec 19, 2012

I got the Pannus removal four weeks ago and I am so glad I did. I lost 50 pounds due to a lapband, and I still have a long way to go to reach my weight loss goals. I am very pleased with the results once the drains came out. Well worth it!

By BoniJ — On Aug 06, 2011

I wonder how many panniculectomies are performed in the U.S. Since it is a very complicated and long surgery with definite risks, I wonder how insurance companies decide to fund one request and not another.

The article says that insurance will consider the very obese, who have trouble moving around or are getting infections and sores all the time. But do the insurance companies consider if other means have been tried to get rid of the fat? If you have pannus, is surgery the avenue of last resort?

By Esther11 — On Aug 05, 2011

For obese and very overweight people, it must be a real trial to have pannus. First, they must deal with moving around with the extra skin and fat hanging down.

Then, if they decide to have a panniculectomy,they need to lose some weight and stay at a particular weight. On top of that, the panniculectomy surgery is risky, involved and long.

And recovery is painful and slow.

This whole procedure must take a toll on the patient's self-esteem.

By lighth0se33 — On Aug 05, 2011

My mother-in-law once was obese. She had gastric bypass surgery, and she lost over 100 pounds. Now, though, she has a bothersome pannus.

Complications with her bypass surgery led to an infection that developed into sepsis. She nearly died from it, and she had to spend a month in the hospital. She’s doing much better now, and she has lost so much weight. Because of this, her pannus is quite large.

However, she has to wait while to get a panniculectomy, because her body needs to be fully recovered from the trauma it endured before undergoing another operation. She is eager to get rid of it, but she is afraid to rush in because of what happened with her last surgery.

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