Rod Franklin

September 30, 2011

September 30, 2011 (Denver, Colorado) — Patients who receive liposuction or liposuction with abdominoplasty might emerge from those procedures with metabolic profiles less attuned to cardiovascular disease and other complications, a recent study of 322 individuals who presented with a range of body mass indices has found.

According to Eric Swanson, MD, a plastic surgeon in Leawood, Kansas, decreases in circulating triglyceride levels and leukocyte counts in both men and women after fat-reduction surgery have a beneficial impact on the reduction of systemic inflammatory status, and might illuminate the role of subcutaneous fat relative to visceral fat in disease mechanisms and type 2 diabetes.

Dr. Swanson presented data from his prospective study here at Plastic Surgery 2011: American Society of Plastic Surgeons Annual Meeting.

"Patients with normal triglyceride levels experienced no significant change after liposuction," he told Medscape Medical News. "However, patients with levels of greater than 150 mg/dL demonstrated a 43% reduction. In fact, 62% of these patients whose levels were at risk before liposuction had normal levels after liposuction."

Triglyceride levels above 150 mg/dL have been associated with an elevated risk for metabolic syndrome, type 2 diabetes, stroke, coronary artery disease, and peripheral vascular disease.

"We do know that the drop in triglyceride levels we found in these patients actually exceeded what can be accomplished medically," Dr. Swanson explained, "so it may be that there is a therapeutic benefit."

Dr. Swanson and colleagues reviewed data from 270 women and 52 men who scheduled fat-reduction procedures over a 2-year period; 22% were considered obese. In the study, 229 underwent superwet ultrasonic liposuction alone and 89 underwent liposuction combined with abdominoplasty. Among the women, 65% underwent lower-body procedures; among the men, 85% underwent trunk fat procedures. Fasting blood tests were performed preoperatively, and at 1 and 3 months postoperatively.

Among the patients undergoing liposuction alone, mean triglyceride levels decreased 26% (P < .05). Of this group, 37% presented with elevated triglyceride levels prior to surgery; that proportion dropped to 18% after the procedure (P < .001).

Patients who underwent liposuction with abdominoplasty experienced reductions that were less dramatic.

Dr. Swanson asserted that this evidence throws light on discussions concerning the metabolic role of fat under the skin, in comparison to the fat that surrounds internal organs.

"A 2004 study published in the New England Journal of Medicine found no difference in lipid levels after liposuction [N Engl J Med. 2004;350:2549-2557]. But that study was limited by the fact that there were only 15 patients — all obese females and all treated in the abdomen only," he said.

"My study found that there is a substantial reduction in triglyceride levels, probably because not all patients were obese. Thus, the fat reduction relative to total body fat was proportionately greater. For decades, the medical community has viewed visceral fat as more harmful than subcutaneous fat. Many studies have challenged this traditional concept. My study suggests that subcutaneous fat is just as important metabolically as visceral fat."

The findings suggest a need for additional research to quantify the true contribution of subcutaneous fat to various disease etiologies, he said.

Al Aly, MD, professor of surgery at the University of California in Irvine, who was not involved in the research, agreed that the question carries a fair amount of clinical significance.

"Visceral fat has function. You can't just go in there willy nilly and cut out visceral fat," he explained. "We need to leave that alone. I don't think that with this scientific paper we can say noncentral (subcutaneous) fat is more important. All you can say is that it may have a role. We don't know the effect of each on cardiovascular health; we need to look at that a little more carefully because we've ignored subcutaneous fat. I think that's a very important point made by this paper. Some of the assumptions that we've made could be wrong, or need to be altered."

Dr. Swanson also observed a significant decrease in mean white blood cell count 3 months after liposuction only (11%; 7030 to 6250 cells/μL; P < .001) and after liposuction with abdominoplasty (12%; 7220 to 6330 cells/μL; P < .001). Previous investigations have found that individuals with higher mean leukocyte counts (8800 cells/μL) have a significantly greater risk for coronary heart disease than those with levels closer to 5600 cells/μL.

No significant changes were recorded in total cholesterol, low-density-lipoprotein cholesterol, or high-density-lipoprotein cholesterol.

"We know...that lower triglyceride levels and lower white counts tend to be associated with fewer health risks," Dr. Swanson concluded. "However, nobody has actually followed a group of patients after liposuction of a period of years to see if they encounter fewer medical problems. This is the logical next step."

Dr. Swanson and Dr. Aly have disclosed no relevant financial relationships.

Plastic Surgery 2011: American Society of Plastic Surgeons (ASPS) Annual Meeting. Presented September 25, 2011.