Why can't I have my panni removed now since it 's causing me so much grief!

Hi - I had RNY 4 years ago.  Top weight was 450# current is 276. (I have gained just under 40#) I am not proud of this however in my defense I have alot of loose hanging flesh most especially in my abdomen area which makes exercising a challenge.  I mostly just walk and have done an ellyptical. I have asked my GP about my panni and he basically says no surgeon will touch you until you drop below 200#.  I am quite discouraged as my weight has bqsically come to a standstill - I am frustrated! I have BXBS insurance and some tell me to just call a PS myself and see what they say?  What do you all think about this?  I would truly love to look and feel better about myself again -my body is a funny shape now! I use spanx when I can stand it on but otherwise I am just a saggy baggy elephant! (at least that's how I feel) Others where I work have had the wls and do not have the skin issues that I do and I am getting tired of those who ask when are you going to get rid of your skin? I feel self counscious enough as it is.  Also do you think it woulde improve on my looks at all? Not being vain, just wondering if my shape will improve thanks for all your help everyone, regaqrds, Mary

I'd just go on and get a referral. You're as good as you're going to get 4 years out on the weight. There's almost no one presenting at 450 lbs who is going to get < 200 lbs. after bypass.

You may be able to have a panniculectomy now. I weigh about 250 (Im 5’10, so BMI of 36), and am scheduled for a lower body lift in two weeks. I spoke with four plastic surgeons, and although I was warned that my risks for a complication would be higher because my BMI is over 30, all of them had no problem with me having a tummy tuck at this time. I have BCBS Federal insurance and was approved for a panniculectomy on the first try, and I am paying the difference for the body lift. The first doctor I consulted with performed a panniculectomy on a woman that weighed about 300 pounds (she had already lost 200 lbs) and removed over 50 pounds of abdominal tissue. After this surgery she was able to exercise and went on to lose even more. He has before and after pictures of this patient on his website if you are interested in an example:

http://www.cincinnatiplasticsurgery.com/index.php?page=Befor eAfter&gallery=56

I would advise you to talk to some plastic surgeons that have a lot of experience with massive weight loss patients. They can determine based on your body composition and overall general health if you are a good candidate for this procedure. Just be aware that your risks for complications are higher, and if you do go on to lose more weight, you may have more loose skin and require a revision. But it may be worth it!

Good luck!

Angela: Thank you so very much for your reply.  I was told by my gp that no ps would even consider me and I was puzzled as to why?  My reasons were this: I have seen people on shows like biggest loser who lost massive amounts of weight but were still obese and yet they seemed to have this surgery or even more involved surgery.  Also a guy in my support group weighted 645# to start, lost 250# or more and had a panni done whe n he was 400# or more and now weighs 340#-still obese but so much more comfortabloe and now he swims and walks for exercise with much more ease and actial enjoyment!
So I basically was just wondering if you all knew why no PS would attempt to even try a panni on a 275# woman who was 4 years out.  The majority of my weight has been lost by the RNY but I am at a standstill now and it is frustrating to me..  I thank you again for your response and I will attempt to at least find out myself from a PS what my options are if any.  Thanks again  Mary

Somelastic surgeons don't want to do surgery on patients with a bmi over 35, others will do it.

If you have it done now, and then lose additional weight you may want a revision, but you won't know I til you get there.

Get a few referrals and interview some plastic surgeons and find out what your options are.

Most surgeons will do a referral for free.

Thanks for your response Kath.  I will attempt to get an opinion on my own.   I thought I needed my gp's referral in order to even see a PS.  I am told this is not so that I can do this on my own.  I would at least like a ps to see me and my skin issues and see what they have to say.  Thanks so much for your reponse!  Mary

It will also depend on your blood test results. The anesthesiologist will need to approve you too. You might want to take in recent blood test results to the consult. The plastic surgeon can feel comfortable but the anesthesiologist will ultimately decide if its safe to put you under to perform the surgery.

My thoughts. We all have a different weight that we are comfortable with as being our stopping point. I had my 360 body lift when I was just a few pounds over 200. My surgeon never said a word about me not being at a charts BMI. When I asked him if I should lose more he said "it's your body and I can't answer that". But he did say that if I plan on losing more that I should wait because having plastics and losing over 15 pounds would change my results. If you are happy where you are and am ready to take the next step in your journey then fight for it, but if your insurance company will only pay once then you'll have more to think about. I'm self pay and did not have anyone to answer to. Another thought on skin removal, I had 16.3 lbs removed but not all of that will reflect on the scale. Skin is full of fluid and the body some of that back. I'm heased in to finish my plastics in 2 weeks and am burrently 195.

Good luck,

 I am in your shoes as well. Some of the surgeons I've dealt with have even been tacky to the point where I don't want to try other surgeons. Keep trying to find someone. I visited with a surgeon in 2006 who was willing to help me when I was 325 lbs., and I'm hoping he is still willing to do so when I go see him later this month. Best of luck.

Thanks Celly for replying.  If I wear some sort of girdle the panni is somewhat contained but I am still morbidly obese.  I am thinking very seriously of joining WW to give myself a goal and lose a bit more and see if this will sway my GP over to my side.  I am not a big fan of more surgery however, every time I  look at my weird shape I am reminded of how much more I need to lose to look like someone "normal".  Just at the point in my life where I am dis satisfied with myslef I guess.  Thanks and I will pursue a surgeon who will listen to my problems and not look at me like I will never ever touch somebody as huge as you are!  Mary