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PubMed1990

Combined suction-assisted lipectomy, surgical lipectomy, and surgical abdominoplasty.

Although combined suction-assisted lipectomy (SAL) and surgical abdominoplasties have been described, the surgical excisions have in general been small and limited to the lower portion of the lower abdomen (i.e., just above the pubis). For the obese patient this is an insufficient lipectomy. SAL alone is unsatisfactory because the marked skin excess will not shrink sufficiently to allow a desired final result. Surgical abdominoplasty alone is also insufficient in the obese patient because the thickness of the abdominal panniculus is not reduced and, additionally, secondary to tissue tension with wound closure, some necrosis of skin above the pubis is not unusual. In this article results are described from a small consecutive series of obese patients treated with a combined extensive SAL, surgical lipectomy, and surgical abdominoplasty. The sequence of fat removal is different than that which has been previously described. In all of the patients the results were pleasing, and there were only two relatively minor complications.

Abdomen↗
PubMed1988

Computerized suction lipectomy aspirator monitor for improved results in suction lipectomy.

A new computerized suction aspirator monitor is described. This device offers the benefits of instantaneous and concurrent scientifically accurate readout of aspirate contents in five separate bodily areas. Thus knowledge of amounts of blood versus fat can be immediately known without resorting to guess, estimate, or cumbersome lipocrit determination by centrifuging. Advantages of such a device include better accuracy in determination of fat removal from each area, with improvement of symmetrical fat removal. More exact determination of blood loss with improved hemodynamic replacement is also more easily and safely accomplished. In an area of mystique, experience, artistry, and aesthetic appreciation which has cloaked the initial enthusiasm for suction lipectomy, a new generation of scientific accuracy is now possible. Thus accurate determination of aspirate content vis-a-vis fat and blood can now transform this procedure into a more sophisticated and scientifically accurate operation which traditionally is desired by most practitioners of suction lipectomy.

Adipose Tissue↗
PubMedDate not supplied

Ultrasonic liposuction versus surgical lipectomy.

Obesity is a serious problem in our century. Nowadays, the incidence of obesity has been increased to 35%. Two common methods for surgical treatment of obesity are surgical lipectomy and ultrasound-assisted liposuction (UAL). This study included 40 patients in two groups, 20 patients in the surgical lipectomy group and 20 patients in the UAL group. Abdominal surgical lipectomy was done in 20 patients (12 female, 8 male), with ages ranging 28-60 years. Abdominal UAL was done in 20 patients (11 females, 9 male), with ages ranging 20-55 years. General anesthesia was used for surgical lipectomy. Tumescent anesthesia was used for 13 UAL patients and general anesthesia was used for the remaining 7. The average time for surgical lipectomy was shorter than that for UAL. The average hospital stay for the surgical lipectomy group was almost five times longer than for UAL. The UAL group also recovered four times faster and required analgesics half as long. The average amount of fat removed in each case was 2.22 kg with UAL and 1.97 kg with surgical lipectomy. The UAL group received analgesic drugs for five days, whereas the surgical lipectomy group received analgesic drugs for 10 days because they sustained more pain. In this study, I do not discuss or compare the major complications of each method because the groups were not large enough. However, there were some minor UAL complications, echymosis in 80%, orthostatic hypotension for three or four days in 75%, infection in one patient, postoperative epidermal loss in small area of the abdomen in two patients, and cellulitis in 75%. All were resolved after one month. UAL is a special method with fewer major complications and shorter hospital stays than surgical lipectomy. The incisions in UAL are smaller, but the operation lasts much longer than surgical lipectomy.

Adult↗
PubMed2003

Autologous fat transplants influence compensatory white adipose tissue mass increases after lipectomy.

Direct tests of the hypothesized total body fat regulatory system have been accomplished by partial surgical lipectomy. This usually results in the restoration of the lipid deficit through compensatory increases in nonexcised white adipose tissue (WAT) masses of ground squirrels, laboratory rats, and mice, as well as Siberian and Syrian hamsters. We challenged this hypothesized total body fat regulatory system by testing the response of Siberian hamsters to 1) lipid deficits [lipectomy; primarily bilateral epididymal WAT (EWAT) removal], 2) lipid surfeits (addition of donor EWAT with no lipectomy), 3) no net change in lipid [EWAT or inguinal WAT (IWAT) lipectomy with the excised fat replaced to a new location (autologous)], 4) lipectomy with the same pad (EWAT lipectomy only) added from a sibling (nonautologous), and 5) sham surgeries for each treatment. Food intake generally was not affected. Body mass was not affected across all treatments. Grafts approximately 3 mo later had normal appearance both macro- and microscopically and were revascularized. The normal lipectomy-induced compensatory increases in nonexcised WAT masses surprisingly were exaggerated with autologous EWAT transplants, but not for autologous IWAT or nonautologous EWAT transplants. There was no compensatory decrease in native WAT masses with nonautologous EWAT additions. Collectively, only lipectomy triggered reparation of the lipid deficit, but the other manipulations did not, suggesting a system biased toward rectifying decreases in lipid or an inability of the hypothesized total body fat regulatory system to recognize WAT transplants.

Adaptation, Physiological↗
PubMed1993

Suction lipectomy: outcome relates to region-specific lipoprotein lipase activity and interval weight change.

To determine the effects of suction lipectomy on regional adipose tissue metabolism, nine women had repetitive circumferential measurements and biopsies of subcutaneous adipose tissue from a lipectomy site (site A) and a nonlipectomy site (site B) up to 12 months following lipectomy. Maximum reductions from preoperative baseline in weight, body mass index, and circumferences of sites A and B occurred at 3 months. Because of variable long-term compliance (6 to 12 months), we created a "last visit" time-point to assess adequately the effects of lipectomy for each individual. Not all subjects maintained reduction in site circumferences from 3 months to the last visit. The change in circumference of site A for that period was highly correlated with the change in circumference of site B (r = 0.828, p = 0.005). The change in circumference of site B, but not site A, at 3 months was related to the weight change above the weight of adipose tissue removed at suction lipectomy. Five subjects who were "sustained responders" to the lipectomy procedure were able to maintain or decrease circumferences of sites A and B from 3 months to the last visit. In contrast, four "limited responders" actually increased circumference of site A and had either no change or increased circumference of site B from 3 months to the last visit. The changes in circumference in both sites between 3 months and the last visit related to changes in body weight over the same interval. Ultimately, the decrement in circumference of site A was 3.4 percent (-2.4 cm) greater than that of site B (p = 0.0001). The response to lipectomy in site B, but not site A, between 3 months and the last visit was related to the change in fasting adipose tissue lipoprotein lipase from baseline to 3 months (r = 0.728, p = 0.026). This change in lipase activity in the control region may represent a metabolic defense of body weight in response to adipose tissue removal in the lipectomy site.

Abdomen↗
PubMed2004

Norepinephrine turnover in brown and white adipose tissue after partial lipectomy.

Total body fat is restored after the surgical removal (i.e., partial lipectomy) of white adipose tissue (WAT), and this is accomplished via increases in the mass of nonexcised WAT pads. The underlying mechanism for this apparent regulation of total body fat is unknown. One possibility is via the sympathetic nervous system (SNS) innervation of WAT and brown adipose tissue (BAT) through the regulation of lipolysis and thermogenesis, respectively. Specifically, decreases in SNS activity might fuel lipectomy-induced body fat compensation through energy saved from decreased BAT thermogenesis and would promote lipid accretion through decreased WAT basal lipolysis. Therefore, we tested whether lipectomy triggered decreases in the SNS drive [as indicated by the norepinephrine turnover (NETO)] to nonexcised WAT or to BAT, at times before the lipectomy-induced fat pad mass compensation was complete. Siberian hamsters received either sham or bilateral epididymal WAT lipectomy, and NETO was measured in the remaining WAT and interscapular BAT (IBAT) before, and 3 and 6 weeks after surgery. Total dissected WAT, and inguinal and retroperitoneal WAT masses were significantly increased following lipectomy, whereas dorsal subcutaneous WAT and IBAT masses, as well as food intake, were unchanged. The only significant change in NETO was a marked decrease (approximately 90%) in IBAT NETO at Week 3 postlipectomy compared with the sham-lipectomized controls. These findings suggest that the lipid accretion of nonexcised WAT pads triggered by lipectomy may be partially fueled by decreased BAT thermogenesis, inasmuch as decreased IBAT NETO reflects decreased BAT heat production.

Adipose Tissue↗
PubMed2003

Submental suction-assisted lipectomy without platysmaplasty: pushing the (skin) envelope to avoid a face lift for unsuitable candidates.

Patients with submental fullness may not be candidates for a full or short-scar face lift because of medical contraindications, uncontrolled hypertension, a refractory nicotine habit, or anticoagulant medications, or patients may disqualify themselves because of cost, unavailable recovery time, or emotional resistance. Submental suction-assisted lipectomy has traditionally been reserved for younger patients. For older patients, suction-assisted lipectomy is typically used as an adjunct for face/neck lifts. This report describes experiences with suction-assisted lipectomy for older patients who were not face lift candidates, for the aforementioned reasons. The study goals were to better delineate the indications for submental suction-assisted lipectomy, as opposed to a face lift, and to obtain improved results with a less-invasive procedure. A 6-year study involving 132 patients (21 to 73 years of age), of whom 4.5 percent were men, was performed. Eighty-eight patients (67 percent), the primary focus of this study, were more than 40 years of age. Of those 88 patients, 24 patients (18 percent of the 132 patients in this series) were in their forties, 45 (34 percent) were in their fifties, 16 (12 percent) were in their sixties, and three (2.3 percent) were at least 70 years of age. The median follow-up time in this series was more than 1 year. The results were assessed with the five criteria for facial rejuvenation described by Ellenbogen and Karlin. All patients demonstrated improvement, with three to five of the Ellenbogen-Karlin neck rejuvenation criteria being met for each patient. All patients demonstrated an improved submandibular border, a more visible anterior sternocleidomastoid muscle border, and an improved neck angle (as determined with angle measurements). For many patients, all five of the Ellenbogen-Karlin criteria were met. A visible subhyoid depression and a visible thyroid cartilage bulge were the two criteria most often not met. A retrospective evaluation using Baker's preoperative classification of patient types for short-scar face lifts was performed. Results for patients more than 64 years of age (11 patients) were less satisfactory, often with redundant or crepe paper-like skin. Submental suction-assisted lipectomy, as opposed to a face lift, was observed to be a reasonable alternative for older patients who were unable or unwilling to undergo a face lift. Localized fullness in the midline was observed to be the best predictor of a good outcome (even better than age or skin tone). A crepe paper appearance of the skin preoperatively was the best predictor of failure. The surgical anatomical features, technique, advantages, disadvantages, and principles are discussed. Complications and their treatment are addressed. It is concluded that submental suction-assisted lipectomy alone, without platysmaplasty, can be helpful for patients with submental fullness who are unsuitable candidates for a face lift and who accept the limitations of liposuction without platysmaplasty. Suction-assisted lipectomy can sufficiently contract and smooth the skin envelope for selected patients, with less consideration for age than previously proposed.

Adult↗
PubMedDate not supplied

Suction lipectomy preceding pregnancy and postpartum results.

A retrospective case-control study was undertaken to determine if women who have undergone suction lipectomy of the abdomen, flanks and lower extremities suffer any reversal of the beneficial results of the procedure as a result of a subsequent term pregnancy and parturition. Cases with two women subjects who became pregnant and experienced full-term pregnancies and healthy childbirth shortly following suction lipectomy of the torso and lower extremities are reviewed. Bodily measurements about significant planes were recorded prior to suction lipectomy, between suction lipectomy and pregnancy, and 32 weeks postpartum. Controls included three women patients who did not become pregnant following the surgery, for whom similar measurements were available pre-suction lipectomy and post-suction lipectomy at short-term and long-term follow-up. The hiatus between follow-ups allowed for a potential gestational period to match the two cases. Results showed insignificant, if any, change between measurements before and after pregnancy in cases; in controls, excellent agreement was also achieved between measurements taken post-surgically at short-term and at long-term follow-up. Assuming normal gravid weight gain and maintenance of proper diet following pregnancy, measurements achieved by suction lipectomy are unaffected by pregnancy and parturition.

Adipose Tissue↗
PubMed1991

Abdominolipoplasty: a system of classification and treatment for combined abdominoplasty and suction-assisted lipectomy.

Criteria for diagnosing abdominal contouring candidates and a new classification system for procedures are presented. The surgical techniques for each of four patient categories of abdominolipoplasty are reviewed: type I--suction-assisted lipectomy alone, type II--mini-abdominoplasty, type III--modified abdominoplasty, and type IV--abdominoplasty with suction-assisted lipectomy. With the combination of suction-assisted lipectomy and abdominoplasty, the majority of patients can actually be treated with a limited abdominoplasty procedure or suction lipectomy. Complications noted in a series of 75 consecutive patients operated on by one surgeon are presented. The blood supply that is relevant to a combination of suction lipectomy with abdominoplasty is outlined. Specific guidelines for these combined procedures are recommended in order to safely combine full abdominoplasties with suction-assisted lipectomies.

Abdomen↗
PubMed1999

Efficacy of lipectomy and liposuction in the treatment of multiple symmetric lipomatosis.

BACKGROUND: Multiple symmetric lipomatosis (MSL) is a rare disease characterized by enlarging, symmetric, nonencapsulated, fat deposits mainly on the neck and upper trunk. Liposuction and lipectomy, although palliative, are the treatments of choice, especially indicated when vital structures are compromised. OBJECTIVE: Our purpose was to evaluate the efficacy and safety of liposuction and lipectomy in the treatment of MSL. METHODS: We have examined two patients diagnosed with MSL who presented with symptoms derived from the compression of vascular, nervous, and/or respiratory tract structures. One was treated with lipectomy and the other with liposuction. RESULTS: A rapid resolution of the clinical symptoms was achieved with both therapies. The patient who was treated with lipectomy suffered from a compression of the left brachial plexus by scar tissue as an adverse effect, requiring a second surgical procedure. Liposuction only provoked a mild autoinvolutive hematoma in the other case. No clinical recurrences were observed at 3 and 2 years of follow-up respectively. CONCLUSIONS: We consider both lipectomy and liposuction as safe and effective techniques for the treatment of MSL patients. Although liposuction is usually associated with less adverse effects than lipectomy, location of the lipomas must be carefully considered before choosing one technique over another.

Adult↗
PubMed2003

Belt lipectomy for circumferential truncal excess: the University of Iowa experience.

When some patients with circumferential truncal excess undergo traditional abdominoplasty, the trunk is not addressed as a unit. Belt lipectomy, a procedure that combines abdominoplasty with circumferential excision of skin and fat, is often more ideal for these patients. In this article, the authors review the literature on belt lipectomy and evaluate their series of 32 patients who underwent belt lipectomy at the University of Iowa. The evolution and current preoperative markings, intraoperative surgical technique, and postoperative care are described. The patients' charts and their preoperative and postoperative photographs were examined retrospectively. It was found that belt lipectomy improved abdominal contour, abdominal wall laxity, mons pubis ptosis, back rolls, waist contour, and buttocks contour. Initially, the procedure was performed on post-weight-reduction patients only, but its indications were extended to three other groups: patients who were 30 to 50 pounds overweight, patients of normal weight who desired a significant overall truncal improvement, and an obese patient with persistent intraabdominal excess. The improvements were significant in all groups of patients except for the latter patient. Complications included a 37.5 percent seroma rate, a 9.3 percent pulmonary embolus rate, and one dehiscence that required reoperation. The authors concluded that belt lipectomy should be seriously considered for patients who present with circumferential truncal excess and for a select group of normal-weight patients. It is not recommended for the obese patient with excessive intraabdominal content. Furthermore, belt lipectomy should be undertaken only in patients who are well informed about the possible risks and complications.

Abdominal Wall↗
PubMedDate not supplied

Viability of fat obtained by syringe suction lipectomy: effects of local anesthesia with lidocaine.

The results of transplantation of free autologous fat obtained by blunt syringe suction lipectomy are unpredictable. We examined if adipose tissue viability is compromised by using syringe suction lipectomy and by infiltration of the tissue with local anesthetics. As reference, we used adipose tissue samples excised during elective surgery. Fat obtained intraoperatively and by lipectomy was digested with collagenase to isolate adipocytes. The mechanical damage associated with sample handling and cell isolation in both procedures was similar and did not exceed 6% of the total cell mass. In addition, cells isolated from intraoperative and lipectomy samples did not differ functionally, responded similarly to insulin stimulation of glucose transport and epinephrine-stimulated lipolysis, and retained the same growth pattern in culture. Since during fat transplantation the graft is exposed to local anesthetics at both the donor and the recipient sites, we reexamined adipocyte function in the presence of lidocaine. Lidocaine potently inhibited glucose transport and lipolysis in adipocytes and their growth in culture. That effect, however, persisted only as long as lidocaine was present; after washing, the cells were able to fully regain their function and growth regardless of whether the exposure was as short as 30 minutes or as long as 10 days. These results indicate that adipose tissue obtained by syringe lipectomy consists of fully viable and functional adipocytes, but local anesthetics may halt their metabolism and growth.

Adipocytes↗
PubMed2005

White adipose tissue sensory nerve denervation mimics lipectomy-induced compensatory increases in adiposity.

The sensory innervation of white adipose tissue (WAT) is indicated by the labeling of sensory bipolar neurons in the dorsal root ganglion after retrograde dye placement into WAT. In addition, immunoreactivity (ir) for sensory-associated neuropeptides such as calcitonin gene-related peptide (CGRP) and substance P in WAT pads also supports the notion of WAT sensory innervation. The function of this sensory innervation is unknown but could involve conveying the degree of adiposity to the brain. In tests of total body fat regulation, partial surgical lipectomy triggers compensatory increases in the mass of nonexcised WAT, ultimately resulting in restoration of total body fat levels in Siberian hamsters and other animals. The signal that triggers this compensation is unknown but could involve disruption of WAT sensory innervation that accompanies lipectomy. Therefore, a local and selective sensory denervation was accomplished by microinjecting the sensory nerve neurotoxin capsaicin bilaterally into epididymal WAT (EWAT) of Siberian hamsters, whereas controls received vehicle injections. Additional hamsters had bilateral EWAT lipectomy (EWATx) or sham lipectomy. As seen previously, EWATx resulted in significantly increased retroperitoneal WAT (RWAT) and inguinal WAT (IWAT) masses. Capsaicin treatment significantly decreased CGRP- but not tyrosine hydroxylase-ir, attesting to the diminished and selective sensory innervation. Capsaicin-treated hamsters also had increased RWAT and, to a lesser degree, IWAT mass largely mimicking the WAT mass increases seen after lipectomy. Collectively, these data suggest the possibility that information related to peripheral lipid stores may be conveyed to the brain via the sensory innervation of WAT.

Adaptation, Physiological↗
PubMed2000

[Abdominoplasty with a combined technique of lipectomy and liposuction].

OBJECTIVE: To evaluate an abdominoplasty technique combined with lipectomy and liposuction. METHODS: Twenty-five patients were undergoing for the abdominoplasty with lipectomy and liposuction in the same operation procedure. A public incision with W-shape was used for the lower abdominal lipectomy, and the upper abdomen was treated with an electronic liposuction technique. After the operation, each patient was followed up for evaluation of the results. RESULT: All of the patients got good contour of the abdomen without obvious complications. The abdominal perimeter was shrunk form 5 cm to 15 cm with over 3 months follow-ups. CONCLUSIONS: The combination of lipectomy and liposuction may be a good and safe method for abdominoplasty. The abdominal flap during the lipectomy could achieve higher survival rate than the traditional technique, due to the less injury on the neurovascular structures sustained by the liposuction procedure.

Abdominal Muscles↗
PubMed1988

Surgical treatment of regional adiposity. Lipectomy versus surgically induced weight loss.

Recognition of abdominal fat distribution as a significant risk factor raised the question whether surgical treatment of regional adiposity might be feasible or desirable. This is a review of cosmetic and therapeutic lipectomy in man and experimental lipectomy in rodents examining morphologic and metabolic aspects as well as conditions for growth and regrowth of adipose tissue. Potentially detrimental metabolic effects of lipectomy are discussed in the context of the "metabolic sink" hypothesis. Data are also presented on the distribution of weight loss after gastrointestinal surgery for morbid obesity. An obesity-related "elephantiasis" syndrome in superobese men is described. "Giant lipectomy" in one such case, removing a record 50 kg during one operation, with pre- and postoperative determination of body fat is reported. It is concluded that lipectomy is not a treatment for obesity with very rare exceptions. Regrowth of adipose tissue is possible under special circumstances. Surgically induced massive weight loss does not seem to cause preferential regional weight loss, though risk-reducing beneficial metabolic effects are achieved after gastrointestinal obesity surgery.

Adipose Tissue↗
PubMed2001

The regulation of total body fat: lessons learned from lipectomy studies.

Surgical removal of body fat (partial lipectomy) is a means of directly reducing fat such that metabolic and behavioral responses can be readily attributed to the lipid deficit. If total body fat is regulated, then lipectomy should trigger compensatory increases in nonexcised white adipose tissue (WAT) mass and/or regrowth at excision sites. Many species, including laboratory rats and mice, show lipectomy-induced compensatory recovery of body fat. Those animals exhibiting naturally occurring annual adiposity cycles, such as ground squirrels and hamsters, do so most impressively reaching seasonally appropriate body fat levels indistinguishable from controls. Reparation of the lipid deficit occurs without an increase in food intake, and generally through enlargement of non-excised WAT mass, rather than regrowth of excised WAT. A body fat regulatory system involving humoral and sensory neural inputs to the brain as well as sympathetic neural outputs from brain to adipose tissue is presented. Collectively, the lipectomy model appears useful for testing mechanisms controlling adiposity, or individual depot growth, and offers insight into how lipid stores fluctuate naturally.

Adipose Tissue↗
PubMed2001

The role of frozen storage in preserving adipose tissue obtained by suction-assisted lipectomy for repeated fat injection procedures.

BACKGROUND: The injection of autologous free fat obtained by suction-assisted lipectomy for the correction of soft tissue defects is a common procedure in plastic surgery. However, unpredictable partial absorption of the injected fat often necessitates repeated procedures. OBJECTIVE: To examine the role of frozen storage as a means of preserving the fat obtained by suction-assisted lipectomy for repeated procedures. METHODS: Human adipose tissue obtained by suction-assisted lipectomy was stored in a domestic refrigerator at -18 degrees C for 2 weeks. After thawing, the fat was injected into nude mice. In the control group, the fat was injected immediately after the harvesting procedure. Grafts were dissected out and compared 15 weeks postinjection. RESULTS: Injected fat survived in both study and control groups. No significant differences were found between fat graft weight and volume, or in any of the histologic parameters examined. CONCLUSION: Fat obtained by suction-assisted lipectomy may be preserved for future use by freezing.

Adipose Tissue↗