Exercise Prevents Regrowth of Fat Following Liposuction

Nancy A. Melville

June 03, 2011

June 3, 2011 (Denver, Colorado) — Fat removed from the abdomen in small-volume liposuction might reemerge in the visceral area within several months; however, regular exercise can significantly reduce the increase of the compensatory fat, according to research presented here at the American College of Sports Medicine 58th Annual Meeting.

Researchers in Brazil randomly divided 36 women who had undergone abdominal liposuction into 2 groups 2 months after surgery. One group of 18 women was assigned to participate in a 4-month exercise program involving aerobic and resistance training; the other group of 18 served as a sedentary control group.

Measurements taken after the 4 months showed that both groups had decreases in abdominal subcutaneous fat, and that the sedentary group had increases in compensatory visceral fat, but the exercise group did not.

Increases in fat-free mass at 4 months were observed only in the exercise group.

Despite liposuction being the most performed aesthetic surgery in the world, evidence of the reemergence of fat after the procedure is surprisingly slim, said lead author Fabiana B. Benatti, from the Laboratory of Applied Nutrition and Metabolism, School of Physical Education and Sport, University of São Paulo, in Brazil.

"Just 1 recently published study has evaluated the possible recovery of fat or the compensatory growth of fat at intact depots, which is usually observed in experimental studies," Dr. Benatti said.

"No study has controlled for the influence of physical activity level. Knowing its effects on body composition, we hypothesized that exercise training would be able to counteract the possible deleterious effects of liposuction on body composition. Our results show that our hypothesis was correct."

The amount of fat removed with liposuction from the women in the study was relatively small (mean fat aspirate supernatant, 1240.3 ± 363.6 mL), and their dietary intake over the 2 months after surgery was unchanged (P > .05).

For those in the 4-month exercise program, activities consisted of aerobic and resistance training 3 times a week. "They underwent aerobic training on a treadmill, [increasing] progressively until it reached 40 minutes per session, and strength training, involving 88 exercises for major muscle groups (1 to 3 series of 8 to 12 [repetitions] per exercise)."

The results indicated that for the patients in both groups, body weight decreased from baseline to 2 months after surgery (P < .05), and returned to baseline levels 6 months after surgery (P > .05).

Interestingly, total fat decreased from baseline to 2 months after surgery in both groups; however, it remained significantly decreased only in the exercise group at 6 months (16.8 ± 3.6 kg; P = .0006).

Fat-free mass was unchanged from baseline to 2 months after surgery in both groups, and increased only in the exercise group after training (< .05).

Abdominal subcutaneous fat was equally decreased in both groups from baseline to 2 months and 6 months after surgery. In the exercise group, abdominal subcutaneous fat content at baseline was 255.8 ± 58.1 cm2, whereas at 6 months it was 166.8 ± 44.3 cm2 (P = .0001). In the sedentary group, abdominal subcutaneous fat content at baseline was 243.6 ± 51.9 cm2 and at 6 months was 170.3 ± 49.3 cm2 (P = .0001).

Although visceral fat was unchanged from baseline to 2 months after surgery in both groups, it significantly increased at 6 months in the sedentary group (41.8 ± 15.5 cm2 vs 46.0 ± 14.8 cm2; P = .05).

Physical capacity also improved only in the exercise group after 6 months of training (P < .05).

Despite reports of compensatory fat after liposuction, Dr. Benatti said that the findings were somewhat unexpected. "We were most surprised at first with the compensatory growth of fat into the visceral cavity," Dr. Benatti said.

"No study had yet shown compelling evidence of this compensatory growth. We were also very pleasantly surprised . . . at the protective effects of exercise, knowing its powerful effects on metabolism and body composition," she explained.

Small-volume liposuction is typically recommended for the removal of stubborn pockets of fat that are not responsive to exercise or diet in people who are at or close to their ideal weight, but the resilience of any compensatory fat has been unclear, said Richard Baxter, MD, plastic surgeon at the Baxter Plastic Surgery Clinic in Mountlake Terrace, Washington, and a spokesperson for the American Society of Plastic Surgeons.

"The fat cells in the areas of fat that don't change even with exercise or diet behave differently than others, making them good targets for liposuction," observed Dr. Baxter.

"The finding that the fat that patients grow back can be controlled with exercise is very good news," he said.

"The fact that people get this compensatory increase in internal fat is not too surprising, but it's encouraging that it is something that can be controlled with diet and exercise, so it fits in the bigger picture of people getting control of their body shape."

Dr. Benatti and Dr. Baxter have disclosed no relevant financial relationships.

American College of Sports Medicine (ACSM) 58th Annual Meeting: Abstract 1893. Presented June 2, 2011.