A once morbidly obese patient who has had significant weight loss may develop a large pannus (fat apron). This can pose a number of problems for the patient.
Complications of a large pannus:
(1) recurrent skin and soft tissue infections (intertrigo, other)
(2) poor hygiene
(3) sexual difficulties
(4) stigma and psychological distress
(5) functional disability
(6) back pain
It is important to document the medical necessity before performing a panniculectomy. An insurance company may claim that it is cosmetic surgery. Therefore, it is important to:
(1) document the patient's medical issues caused by the pannus
(2) demonstration that alternative therapies have failed
(3) document the size of the pannus with photographs. The pannus must hang below the level of the mons pubis in many cases.
(4) document that the patient has not gained weight for predetermined period (12 to 24 months)
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