title: Women gain weight and fat mass despite lipectomy at abdominoplasty and breast reduction. Is dermolipectomy effective in improving insulin action and lowering inflammatory markers in obese women? Photographic Measurements in 301 Cases of Liposuction and Abdominoplasty Reveal Fat Reduction without Redistribution Liposuction induces a compensatory increase of visceral fat which is effectively counteracted by physical activity: a randomized trial. Quality of Life After Abdominoplasty in Women After Bariatric Surgery C-Reactive Protein Decrease After Postbariatric Abdominoplasty Effect of Surgically Removing Subcutaneous Fat by Abdominoplasty on Leptin Concentrations and Insulin Sensitivity Fat redistribution following suction lipectomy: defense of body fat and patterns of restoration. Prospective Clinical Study Reveals Significant Reduction in Triglyceride Level and White Blood Cell Count after Liposuction and Abdominoplasty and No Change in Cholesterol Levels
abstract: OBJECTIVES In animal models , fat removal results in compensatory weight gain . No study has reported measurement of weight following lipectomy in humans . We have examined changes in weight in patients who underwent lipectomy .  METHODS In a retrospective analysis , 16 patients who had abdominoplasty and 17 patients who underwent bilateral breast reduction were compared with 16 patients who had carpal tunnel syndrome release . Following this , a prospect i ve study was carried out on 7 subjects awaiting abdominoplasty and 12 subjects awaiting bilateral breast reduction surgery .  RESULTS In the retrospective study , all three patient groups gained weight following surgery . The abdominoplasty group was heavier before surgery and showed greatest weight gain but there was no statistically significant difference in weight gain between the groups . In the prospect i ve study , the abdominoplasty group had a mean fat removal of 1.77 kg and breast reduction group had a mean of 3.22 kg . Eighteen months following surgery the abdominoplasty group showed a significant mean increase in body weight ( mean increase : 4.82 kg ) and body mass index ( BMI ) ( mean increase : 1.66 kg/m(2 ) ) . In the bilateral breast reduction group , there was a non-significant mean gain in weight ( mean increase : 0.67 kg ) and BMI ( mean increase : 0.21 kg/m(2 ) ) . CONCLUSIONS Patients undergoing lipectomy during abdominoplasty and bilateral breast reduction will gain weight in the long term . This weight gain probably reflects the expected gain in weight without surgery as a similar finding is observed in patients who have undergone surgery without lipectomy  . These results highlight the limitation of lipectomy as a weight control measure Objective Obesity is a major risk factor for coronary heart disease , and surgical treatment of obese patients as part of a multidisciplinary approach seems to provide faster results than diet therapy . The aim of this study was to evaluate the effect of  dermolipectomy  on insulin action and inflammatory markers in 20 obese women Background : There are no published studies of liposuction or abdominoplasty in a large number of patients using measurements of body dimensions . In the absence of rigorous data , some investigators have proposed that fat returns after liposuction . Methods : A prospect i ve study was undertaken among predominantly nonobese consecutive patients undergoing 301 liposuction and abdominoplasty procedures meeting the study criteria ( inclusion rate , 70.7 percent ) .  Lower body dimensions were measured using st and ardized photographs taken before and at least 3 months after surgery . Upper body measurements were compared between women who underwent simultaneous cosmetic breast surgery ( n = 67 ) and a group of women who had breast surgery alone ( n = 78 ) to investigate the possibility of fat redistribution . Results : The average weight change was a loss of 2.2 lbs after lower body liposuction ( p < 0.01 ) and 4.6 lbs when combined with abdominoplasty ( p < 0.001 ) . Liposuction significantly reduced abdominal , thigh , knee , and arm width ( p < 0.001 ) . Midabdominal and hip width were more effectively reduced by lipoabdominoplasty than liposuction alone ( p < 0.001 ) . There was no difference in upper body measurements when comparing patients who had simultaneous liposuction and /or abdominoplasty with patients who had cosmetic breast surgery alone . Measurements in patients with at least 1 year of follow-up ( n = 46 ) showed no evidence of fat reaccumulation . Conclusions : Both liposuction and abdominoplasty are valid techniques for long-term fat reduction and improvement of body proportions . There is no evidence of fat regrowth . CLINICAL QUESTION /LEVEL OF EVIDENCE : Therapeutic , III CONTEXT Liposuction is suggested to result in long-term body fat regain that could lead to increased cardiometabolic risk . We hypothesized that physical activity could prevent this effect . OBJECTIVE Our objective was to investigate the effects of liposuction on body fat distribution and cardiometabolic risk factors in women who were either exercise trained or not after surgery . DESIGN , SETTING , AND PARTICIPANTS Thirty-six healthy normal-weight women participated in this 6-month r and omized controlled trial at the University of Sao Paulo , Sao Paulo , Brazil . INTERVENTIONS Patients underwent a small-volume abdominal liposuction . Two months after surgery , the subjects were r and omly allocated into two groups : trained ( TR , n = 18 , 4-month exercise program ) and nontrained ( NT , n = 18 ) . MAIN OUTCOME MEASURES Body fat distribution ( assessed by computed tomography ) was assessed before the intervention ( PRE ) and 2 months ( POST2 ) , and 6 months ( POST6 ) after surgery . Secondary outcome measures included body composition , metabolic parameters and dietary intake , assessed at PRE , POST2 , and POST6 , and total energy expenditure , physical capacity , and sc adipocyte size and lipid metabolism-related gene expression , assessed at PRE and POST6 . RESULTS Liposuction was effective in reducing sc abdominal fat ( PRE vs. POST2 , P = 0.0001 ) . Despite the sustained sc abdominal fat decrement at POST6 ( P = 0.0001 ) , the NT group showed a significant 10 % increase in visceral fat from PRE to POST6 ( P = 0.04 ; effect size = -0.72 ) and decreased energy expenditure ( P = 0.01 ; effect size = 0.95 ) when compared with TR . Dietary intake , adipocyte size , and gene expression were unchanged over time . CONCLUSION Abdominal liposuction does not induce regrowth of fat , but it does trigger a compensatory increase of visceral fat , which is effectively counteracted by physical activity Background Abdominal skin overhang is not unusual after massive weight loss induced by antiobesity interventions , and poor quality of life should be feared in such circumstances , especially in women . However , long-term results of quality of life have not been often documented in this setting . With the purpose of addressing this question , a prospect i ve study was design ed . Methods Patients ( n = 16 , 100 % females , age 40.1 ± 8.0 years ) su bmi tted to st and ard or combined circumferential abdominoplasty  were recruited for this study . All had undergone open Roux-en-Y gastric bypass between 24 and 48 months earlier with stable weight in the last 12 months . Quality of life was assessed by a trained psychologist employing of a semistructured interview , the Adaptative Operationalized Diagnostic Scale ( AODS ) , covering affectivity/personal relations , productivity , social/cultural performance , and organic/somatic health . Results Circumferential abdominoplasty was followed by few problems ( serous fluid collection s in 18.8 % , anemia because of blood loss in 6.3 % ) . The best overall response to the AODS question naire corresponded to the social and cultural domain where 81.3 % of the patients had excellent adaptation ( level 1 ) . For the other three domains , results were remarkably similar with 62.5 % of the tests displaying the highest value of adaptation and rare total failures . Conclusions ( 1 ) The current operation corresponded to the expectations of the patients with few complications and favorable body contouring result . ( 2 ) Quality of life , quantified by means of adaptation and social adjustment scores , was adequate in most circumstances . ( 3 ) Outst and ing responses for social/cultural performance were registered with encouraging findings for affectivity/personal relations , productivity , and organic/somatic health as well In a prospect i ve study , indices of glucose homeostasis , lipid profile , and systemic inflammation were monitored after an  aesthetic abdominoplasty  , aim ing to scrutinize the possible metabolic benefits for abdominal fat removal . Premenopausal females with substantial weight loss ( N = 40 ) undergoing circumferential abdominoplasty ( index group , n = 20 ) or augmentation mammoplasty with mastopexy ( controls , n = 20 ) were recruited . All of them originally underwent Roux-en-Y gastric bypass .  Variables included BMI , white blood cell count , C-reactive protein , hemoglobin , total cholesterol and fractions , triglycerides , glucose , and HbA1c . Follow-up reached 20.3 ± 13.6 months for index cases and 29.5 ± 17.4 months for controls . The metabolic and inflammatory indices improved after the bariatric surgery . Subsequent monitoring indicated a stable body weight and biochemical profile in both groups . The exceptions were HDL cholesterol and C-reactive protein , which respectively increased and diminished after the abdominoplasty , consistent with an inflammatory and metabolic advantage for this operation . This is the first long-term study in a weight-stable population to point out such a pattern after abdominoplasty The aim of this study was to identify the effect of surgically removing subcutaneous fat by abdominoplasty on leptin concentrations and insulin sensitivity . An open clinical trial with a noninterventional parallel group was carried out in 12 obese women . After r and omization , 6 volunteers were selected for abdominoplasty  , and the other 6 women were considered as the noninterventional group . A metabolic profile , including leptin concentrations , and insulin tolerance test to assess insulin sensitivity were performed on all volunteers before intervention or nonintervention and 40–50 days afterward . A significant reduction in body mass index ( 30.7 ± 0.9 versus 29.6 ± 0.7 kg/m2 ; P = 0.02 ) and in leptin concentrations ( 41.3 ± 10.6 versus 32.0 ± 10.2 ng/mL ; P = 0.02 ) was observed after abdominoplasty . Insulin sensitivity did not change after intervention . In conclusion , surgically removing subcutaneous fat by abdominoplasty  decreased leptin concentrations , with no change in insulin sensitivity No r and omized studies in humans have examined whether fat returns after removal or where it returns . We undertook a prospect i ve , r and omized-controlled trial of  suction lipectomy in nonobese women to determine if adipose tissue ( AT ) is defended and if so , the anatomic pattern of redistribution . Healthy women with disproportionate AT depots ( lower abdomen , hips , or thighs ) were enrolled . Baseline body composition measurements included dual-energy X-ray absorptiometry ( DXA ) ( a priori primary outcome ) , abdominal/limb circumferences , subcutaneous skinfold thickness , and magnetic resonance imaging ( MRI ) ( torso/thighs ) . Participants ( n = 32 ; 36 ± 1 year ) were r and omized to small-volume liposuction ( n = 14 , mean BMI : 24 ± 2 kg/m(2 ) ) or control ( n=18 , mean BMI : 25 ± 2 ) following baseline . Surgery group participants underwent liposuction within 2 - 4 weeks . Identical measurements were repeated at 6 weeks , 6 months , and 1 year later . Participants agreed not to make lifestyle changes while enrolled . Between-group differences were adjusted for baseline level of the outcome variable . After 6 weeks , percent body fat ( % BF ) by DXA was decreased by 2.1 % in the lipectomy group and by 0.28 % in the control group ( adjusted difference ( AD ) : -1.82 % ; 95 % confidence interval ( CI ) : -2.79 % to -0.85 % ; P = 0.0002 ) . This difference was smaller at 6 months , and by 1 year was no longer significant ( 0.59 % ( control ) vs. -0.41 % ( lipectomy ) ; AD : -1.00 % ; CI : -2.65 to 0.64 ; P = 0.23 ) . AT reaccumulated differently across various sites . After 1 year the thigh region remained reduced ( 0.77 % ( control ) vs. -1.83 % ( lipectomy ) ; AD : -2.59 % ; CI : -3.91 to -1.28 ; P = 0.0001 ) , but AT reaccumulated in the abdominal region ( 0.64 % ( control ) vs. 0.42 % ( lipectomy ) ; AD : -0.22 ; CI : -2.35 to 1.91 ; P = 0.84 ) . Following suction lipectomy , BF was restored and redistributed from the thigh to the abdomen Background : Triglyceride levels of 150 mg/dL or greater are known to be associated with an increased cardiovascular risk and metabolic syndrome . This study investigated the effect of liposuction and abdominoplasty on lipid levels , complete blood count , and other parameters . Methods : A prospect i ve study was undertaken among 322 consecutive patients ( 270 women and 52 men ) who presented for liposuction ( n = 229 ) , abdominoplasty with liposuction ( n = 87 ) , and abdominoplasty without liposuction ( n = 6 ) . The mean body mass index was 26.6 kg/m2 ( range , 18.6 to 44.1 kg/m2 ) . Ultrasonic liposuction using a superwet infusion technique was used in all cases , usually treating the lower body in women ( 64.4 percent ) and the trunk in men ( 86.5 percent ) . Results : Mean weight loss 3 months after liposuction was 2.2 lbs for liposuction alone ( p < 0.001 ) and 4.2 lbs for liposuction and abdominoplasty ( p < 0.05 ) . Mean fasting triglyceride level decreased 25.7 percent after liposuction ( p < 0.001 ) . The triglyceride level decreased 43.0 percent ( n = 56 , p < 0.001 ) after liposuction in patients with preoperative levels of 150 mg/dl or greater . There was a significant decrease in white cell count after both liposuction and liposuction/abdominoplasty ( p < 0.001 ) . There were no significant changes in total , low-density lipoprotein , or high-density lipoprotein cholesterol . Fasting glucose was unchanged . Conclusions : A significant ( p < 0.001 ) reduction in triglyceride level in patients with elevated preoperative levels and a significant decrease in leukocyte count ( p < 0.001 ) are favorable metabolic effects of liposuction and liposuction/abdominoplasty . Cholesterol levels are unaffected . CLINICAL QUESTION /LEVEL OF EVIDENCE : Therapeutic , IV
target: These results corroborate the evidence from experimental and clinical studies , which support fat redistribution and compensatory fat growth , as a result of feedback mechanisms , triggered by fat removal .
background: Adipose tissue is considered as an endocrine organ , which is developed in specific depots , distinguished either as subcutaneous or visceral .
  Lipectomy , by means of liposuction or abdominoplasty , is a common plastic surgery procedure , which can remove substantial amounts of subcutaneous fat .
  This systematic review aims to evaluate the impact of surgical removal of abdominal subcutaneous adipose tissue on  body weight and fat mass in females in the short- and long-term .