Fat Redistribution Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration

Abstract

No randomized studies in humans have examined whether fat returns after removal or where it returns. We undertook a prospective, randomized‐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 randomized to small‐volume liposuction (n = 14, mean BMI: 24 ± 2 kg/m2) 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.

Estrogen Sulfotransferase/SULT1E1 Promotes Human Adipogenesis

“…That number is maintained tightly throughout an individual's adult life, despite long-term changes in diet and exercise that may result in a dramatic weight loss. It was reported that even after lipectomy in nonobese female patients, body fat regenerates and redistributes, particularly to the abdominal region (38). This phenomenon was also recapitulated in mouse models (39).…”

Lower body adipose tissue removal decreases glucose tolerance and insulin sensitivity in mice with exposure to high fat diet

“…Adipose tissue removal in humans 18,23,24 and rodents 30,35 induces compensation in remaining nonexcised adipose tissue depots. Rodent studies demonstrate that compensatory adipose depot mass differences are not detectable 5 weeks post-surgery, 55 but significant compensatory redistribution of lipids to non-excised adipose depots occurs »12 weeks post-surgery.…”

“…22 There is evidence in humans that liposuction increases body fat in non-excised areas, 23,24 such as central/visceral adipose tissue depots. 18 This redistribution of lipid to other adipose tissue depots, in particular visceral adipose tissue, may override, supersede and/or contribute to effects induced directly by LBSAT removal. Thus, to investigate the specific role of LBSAT in glucose homeostasis requires a model in which this depot can be removed without significant compensatory accumulation of lipid in other adipose tissue depots.…”

“…21 The lack of effect following liposuction, however, may be related to the fact that subjects were morbidly obese prior to and after the procedure. Other studies that have either concluded that liposuction was with 19,20 or without effect [16][17][18] were also confounded by wide variations in BMI (24 to 50), age (18-50 C years), duration of study (12 weeks to years) and amount of adipose tissue removed (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). [16][17][18][19][20] Although liposuction/lipectomy remains a useful tool to evaluate the role of LBSAT in relation to metabolic abnormalities, human data remains inconsistent due, in part, to variability in experimental approach and study populations.…”

“…[10][11][12][13][14] It has been proposed that lower body subcutaneous adipose tissue (LBSAT) functions as a "metabolic sink," storing lipids that might otherwise lead to disturbances in nonadipose tissues. 15 Although metabolic outcomes associated with LBSAT removal in humans have been investigated, [16][17][18][19][20] the "metabolic sink" postulate has not been systematically examined, in part, due to inherent experimental limitations in humans. Large volume reduction of LBSAT, via liposuction, does not alter insulin sensitivity or circulating markers of inflammation in humans.…”