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PubMed2005

Effects of white adipose tissue grafts on total body fat and cellularity are dependent on graft type and location.

Surgical removal of body fat (lipectomy) triggers compensatory increases in nonexcised white adipose tissue (WAT), thus restoring adiposity levels in many species, including Siberian hamsters. In Siberian hamsters, when their lipectomized WAT is transplanted to another site (autologous grafts, no net change in body fat), healthy grafts result, but the lipectomy-induced compensatory increases in nonexcised WAT masses are exaggerated, an effect that apparently occurs only when the grafts contact intact WAT. When WAT is added to nonlipectomized hamsters to increase body fat, native WAT pads do not decrease. Thus WAT addition or removal-replacement does not induce compensatory WAT responses consistent with total body fat regulation as does WAT subtraction. Therefore, we tested whether the exaggerated response to lipectomy occurring with autologous WAT transplantation is dependent on graft site placement and whether the donor graft source [inguinal or epididymal WAT (IWAT, EWAT), sibling vs. nonsibling] affected body fat responses to WAT additions in nonlipectomized hamsters. Lipectomized hamsters received subcutaneous autologous EWAT grafts placed remotely from other WAT (ventrum) or in contact with intact WAT (dorsum), whereas intact hamsters received EWAT or IWAT grafts from sibling or nonsibling donors. The exaggerated response to lipectomy only occurred when grafts were in contact with intact WAT. EWAT, but not IWAT, additions to nonlipectomized siblings or nonsiblings increased native IWAT and retroperitoneal WAT mass but not EWAT mass compared with controls. Collectively, WAT transplantation to either lipectomized or nonlipectomized hamsters increased body fat contingent on graft contact with intact or native WAT.

Adaptation, Physiological↗

PubMed2000

Report on bariatric surgery in the Ukraine.

BACKGROUND: Morbid obesity (MO) is a problem internationally, including in the Ukraine. We present the surgical treatment of MO in the Ukraine over the last 15 years, during which intestinal bypasses and various gastric reduction procedures were performed. METHODS: 198 patients with MO underwent: jejunoileal (JI) bypass 64, non-adjustable gastric banding (NGB) 34, Roux-en-Y gastric bypass (RYGBP) 1, horizontal gastroplasty 1, vertical banded gastroplasty (VBG) 2, and abdominal lipectomy 96. The 96 men and 102 women weighed 160-290 kg (mean 210+/-SD18 kg). Mean body mass index was >60 kg/m2. These patients had a high incidence of hypertension, diabetes, sleep apnea, menstrual disorders, impotency in men and infertility in women. RESULTS: At 1 year, after JI bypass 61 patients lost a mean of 62+/-17 kg and after NGB 11 kg. After JI bypass, 1 patient died in the early postoperative period from acute respiratory insufficiency and 2 died in the first year from acute liver insufficiency. The JI bypass was reversed in 2 patients due to uncontrollable malabsorption syndrome; 1 year after reversal, the weight of these patients exceeded their preoperative weight. In the early postoperative period, 1 patient died after NGB and 1 after RYGBP, from acute respiratory insufficiency. Postoperative weight loss was associated with decrease in the co-morbidities of MO, but after JIB, there was a high incidence of bypass enteritis, excessive malabsorption, formation of renal stones and gallstones. After NGB, no complications have been identified. Isolated lipectomy was performed in 44 patients, lipectomy combined with a bariatric operation in 31, and lipectomy after loss of the excess body weight in 21. CONCLUSIONS: Bariatric surgery was very effective in weight loss, accompanied by reduction or disappearance of the co-morbidities of MO, with considerable improvement in quality of life.

Adolescent↗

PubMed1984

Effects of castration on adipose tissue growth and regrowth in the male rat.

Adipose tissue has been found to regrow in the male rat following surgical removal (lipectomy) of inguinal subcutaneous depots, but the degree of regrowth has varied widely across experiments. It is possible that at least part of the disparity of previous findings occurred because of differences among the experiments in the testicular integrity of experimental animals. To address this possibility, the present study examined effects of castration on adipose tissue regrowth in rats treated either as weanlings or as young adults. Male Sprague-Dawley rats, at either 4 or 15 weeks of age, were subjected to one of four surgical procedures: bilateral lipectomy of the inguinal subcutaneous depots; castration; lipectomy and weight gain, but castrated rats achieved a higher ratio of adipose weight to body weight than noncastrated rats. In rats lipectomized but not castrated at 15 weeks of age, partial regeneration and a small increase in growth of noninguinal subcutaneous adipose tissue combined to produce substantial restoration of adipose mass. The same surgery in 4-week-old rats did not result in significant restoration because growth of noninguinal subcutaneous adipose tissue was reduced. In rats that were both castrated and lipectomized, regrowth of adipose tissue was substantial regardless of age at time of surgery. Thus, castration is seen to impede body weight gain while sparing ordinary growth of adipose tissue and facilitating regrowth of adipose tissue following lipectomy. Since adipose tissue regrowth varied with age only in noncastrated rats, it appears to be facilitated as well by testicular maturation.

Adipose Tissue↗

PubMed2000

Fathers, fat, and maternal energetics in a biparental hamster: paternal presence determines the outcome of a current reproductive effort and adipose tissue limits subsequent reproductive effort.

Djungarian hamster females, Phodopus campbelli, are severely constrained in their ability to reproduce successfully and lose 20% of their body weight by the time pups are weaned. In the wild and in the laboratory, biparental care improves maternal reproductive success. Two experiments quantified the effects of paternal presence and partial lipectomy [surgical depletion of parametrial white adipose tissue (PWAT) on day 8 of the 18-day gestation] on maternal energy balance, reproductive success, and investment in a subsequent reproductive attempt. Paired females reproduced successfully, maintained body weight, and invested in a second litter. Removal of the male decreased pup survival, growth, and readiness for dispersal by 18 days of age. Solitary females lost 10% of their body weight by the birth and a further 10% by day 18 after the birth. Thus, paternal presence balanced maternal energy budgets during reproduction and prevented a 20% loss in body weight. Equivalent weight loss occurs in response to other maternal stressors, therefore 20% may be the maximum tolerable weight loss in this species. Fresh weight of interscapular brown adipose tissue was predicted by the extent of maternal hyperthermia but not by maternal energy balance or lipectomy. Partial lipectomy did not adversely affect the female or the first litter but decreased the probability of investment in a second reproductive attempt and halved the size of the second litter. This effect may have been due to the 0.1% of body weight amount of lipid removed or may reflect a specialized role for PWAT in adjusting maternal investment.

Adipose Tissue↗

PubMed1998

Rejuvenation of the upper arm.

During the course of life, the upper arm demonstrates skin relaxation and fat deposits that become increasingly evident, particularly with age. However, the degree of skin ptosis and accumulation of subcutaneous fat varies from patient to patient. Therefore, it is critical to evaluate each patient individually, to inform the patient of the available options, and to tailor the procedure to his or her needs. We have described four categories of upper-arm problems. Patients with minimal to moderate subcutaneous fat and minimal skin laxity generally do well with circumferential lipectomy alone. With an increased amount of subcutaneous fat and more pronounced skin laxity, suction lipectomy in conjunction with a "ridge" provides good results, with a well hidden scar in the axilla. In the obese patient in whom skin laxity becomes much more noticeable after suction lipectomy, we recommend a purse-string closure of the modest brachioplasty incision to decrease the scar size. In those patients who have minimal fat but extensive skin laxity, a traditional brachioplasty cannot be avoided. Carefully selected and properly informed patients will result in an extremely high satisfaction rate. The techniques and guidelines described are designed to provide simple, easily performed procedures with minimal complications that safely and effectively rejuvenate the upper arm.

Adipose Tissue↗

PubMed2000

Abdominoplasty and abdominal wall rehabilitation: a comprehensive approach.

Standard abdominoplasty techniques involve a low horizontal or W skin excision, muscle plication, and umbilical transposition. Newer techniques include suction-assisted lipectomy, the use of high lateral tension with fascial suspension, and external oblique muscle advancement. The author has modified these traditional procedures and added new techniques to improve the aesthetic and functional results of the abdominoplasty procedure. This modification provides a comprehensive approach to abdominal wall aesthetic improvement and rehabilitation. The comprehensive approach described includes four components: the "U-M dermolipectomy," "V umbilicoplasty," the rectus abdominis "myofascial release," and suction-assisted lipectomy. The patient is marked while standing for areas of suction lipectomy and undermining. The lower incision is designed as an open U with the lateral limbs placed inside the bikini line. The upper incision is a lazy M with the higher peaks located at the level of the flanks. Subcutaneous hydration is achieved to perform suction along the flanks, waistline, and iliac areas. Gentle suction of the flaps is also performed. The umbilicus is cored out in a heart shape. The flaps within the U-M marks are excised, and the undermining is performed to the xiphoid and costal margins. The rectus diastasis is marked, and the anterior rectus fascia is incised at the junction of the medial third with the central third of the width of the rectus sheath. Horizontal figure-eight plication sutures by using the lateral fascial edge enable easier infolding of the central tissue. The new recipient of the umbilicus is made by an incision in a V shape on the abdominal flap. The umbilicus is telescoped, and the triangular flap of the abdomen is sutured to the triangular defect of the umbilicus. Skin flap fixation to the umbilicus relieves tension in the lower portion of the flap. The upper skin flap, which is cut in an M manner, provides lateral tension and matches the length of the lower flap. A standard fascial suspension is used and closure is performed in layers. The techniques described here are intertwined procedures. Each facilitates the accomplishment of the other procedure, and they complement each other. They all attain the 12 objectives of the abdominoplasty described. These combined techniques have been used in 104 patients in a period of 11 years. Complications were minimal and easily manageable, except for one patient who required excision of a pseudobursa and retightening of the lower quadrants of the abdominal wall musculature to correct extreme lordosis. A comprehensive approach for the treatment of complex abdominal wall aesthetic and functional defects is presented. These require thoughtful integration of the four components mentioned. This approach has allowed predictable, reproducible, and aesthetically pleasing results.

Abdominal Muscles↗

PubMed2005

The "anterior-only" approach to neck rejuvenation: an alternative to face lift surgery.

BACKGROUND: The ideal procedure for those patients with aging of the lower face and neck is a cervicofacial rhytidectomy. However, within this group is a subset of patients whose goals can be met with a lesser procedure. These patients must be interested in profile change only, with no desired change in the midface. METHODS: Patients undergoing neck rejuvenation by means of a submental approach fall into three groups: (1) patients with obtuse cervicomental angles and good skin elasticity (who may be treated with liposuction alone); (2) patients with subplatysmal fat or mild to moderate skin and muscle laxity (these patients are best treated by anterior lipectomy and platysmaplasty); and (3) patients with marked skin excess or severe skin laxity (best treated by procedures with excised skin, i.e., traditional face lift or direct excision of neck skin and Z-plasty). RESULTS: Thirty-three consecutive patients with mild (grade II, 16 patients), moderate (grade III, 11 patients), and severe (grade IV, six patients) cervicomental angle deformities were treated with anterior platysmaplasty and submental lipectomy. Twenty of 33 patients improved by one grade (61 percent), whereas 12 of 33 improved by two grades (36 percent). CONCLUSIONS: Young patients with minimal subplatysmal fat can be treated by liposuction alone. Patients with subplatysmal fat and mild or moderate skin or muscle laxity will obtain consistent results with platysmaplasty and submental lipectomy. Skin excisional procedures are reserved for those patients with severe skin excess or laxity.

Adult↗

PubMed1995

[Removal of the sagging of the tissues in the submental area].

Twenty out of 100 patients operated on to remove skin excess on the face and neck had slackening tissue under the chin. Based on published data and their findings, the authors developed operations to remove slackening tissue under the chin and carried out such operations in 64 patients. Isolated lipectomy failed to bring about good results in cases when there were indications for removal of skin excess on the face neck (10 patients). Simultaneous removal of skin excess on the face and lipectomy helped attain good results in 50 patients. The operation is possible in patients with a low position of the sublingual bone, although the results are not so good. Lipectomy in the area under the chin is recommended as a method supplementing operation for removal of skin excess on the face and neck.

Chin↗

PubMedDate not supplied

Soft tissue composition in upper leg lipodystrophy: application of dual energy x-ray absorptiometry.

Liposuction is a safe procedure for removal of subcutaneous fat in patients with upper leg lipodystrophy. We present a young woman with lipodystrophy of upper leg who underwent ultrasound-assisted three-dimensional suction lipectomy. The aim of the study was to determine the amount of fat to be removed before liposuction and to evaluate soft tissue composition before and after liposuction. At the initial meeting and four months later, body composition parameters were examined by dual X-ray absorptiometry (DXA), which produced a precise assessment of regional fat distribution. The baseline DXA measurements revealed excess of fat tissue for the lateral regions of the right and left legs, and for the area from the waist to hip. After liposuction of established amount of tissue, the same measurements revealed a decrease of fat tissue in all three regions, whereas no significant differences were observed for lean mass. We concluded that the suction lipectomy produced decrease in the fat mass of legs without musculature damage. The DXA technique can be useful in predicting fat removal before suction lipectomy and in estimating changes in soft tissue composition after surgical treatment.

Absorptiometry, Photon↗

PubMed1985

Brown fat thermogenesis and its role in the development of obesity.

The role of brown fat thermogenesis in the development of obesity is considered from a number of perspectives. In adult rats, the impact of scapular brown fat lipectomy on carcass fat accretion was examined in three different rodent models: the Zucker lean (Fa/-) rat which is relatively resistant to obesity, the Zucker obese (fa/fa) rat which is characterized by a particularly severe form of hyperplastic obesity and the Osborne Mendel rat which remains lean on a standard pelleted diet but readily becomes obese on a palatable high fat diet. The consequences of brown fat lipectomy varied from no effect on carcass white fat accretion in Zucker Fa/- lean rats to a significant increase in adiposity in the Zucker fatty fa/fa relative to their respective sham-operated controls. The effect of the Osborne Mendel rat was intermediate between the Fa/- and the fa/fa. The results point to the importance of genetic background with respect to the impact of brown fat lipectomy on the development of white fat adiposity. In the developing Zucker rat at 2 and 8 days of age, in vivo evidence is presented to support the concept that brown fat thermogenesis is attenuated in the fatty fa/fa preobese pup. In animals of the fatty fa/fa genotype, maximum oxygen consumption in response to acute cold exposure was lower than in lean pups of the Fa/Fa genotype. Moreover, at 8 days of age, the rectal temperature of the cold-exposed fa/fa pups fell more precipitously than did that of the lean during the period of cold exposure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue, Brown↗

PubMed2001

Surgical treatment of Graves orbitopathy: a modified balanced technique.

Surgery has a definite place in the treatment of the exophthalmos in Graves orbitopathy. Thirty-two patients with Graves orbitopathy were operated on. Twenty patients received a three-wall orbital decompression. Five patients received a two-wall orbital decompression with lipectomy and seven patients underwent a two-wall orbital decompression combined with an advancement osteotomy of the supra-, lateral- and infra-orbital rim and a lipectomy. In cases with Hertel values less than 25 mm, the two-wall orbital decompression with removal of orbital fat. and in cases with Hertel values more than 25 mm, the two-wall orbital decompression with lipectomy and an advancement osteostomy of the supra-, lateral- and infraorbital rim is the treatment of choice.

Adolescent↗

PubMed1984

Scapular brown fat removal enhances development of adiposity in cold-exposed obese Zucker rats.

To investigate the contribution of brown fat (BAT) to the development of obesity in genetically obese Zucker rats (fa/fa), scapular brown fat (SBAT) was removed from obese and lean 4-wk-old females. Eight weeks after surgery there was no regrowth of SBAT. Lipectomy had no effect on body weight gain, food intake, and body composition when rats were housed at 25 degrees C. Lean rats completely compensated for the lipectomy by increasing BAT mass, protein, cellularity, and activity of citrate synthase (CS) in axillary, perirenal, and thoracic depots. beta-Hydroxyacyl-coenzyme A dehydrogenase (HOAD) activity was increased, but compensation was incomplete. In lipectomized obese rats, only BAT protein and cell number were increased sufficiently for complete compensation. In a second experiment SBAT was removed from obese and lean rats, but rats were housed in the cold (10 degrees C) for 8 wk. In lean rats, although compensation was incomplete, it was sufficient to maintain a weight gain and body composition comparable with sham-operated lean rats. In obese rats, where there was little or no compensation for lipectomy, weight gain and fat deposition were greater than observed in sham-operated obese controls. These data support the hypothesis that reducing the amount of functional BAT contributes to the development of increased adiposity.

3-Hydroxyacyl CoA Dehydrogenases↗

PubMed2006

[Diagnosis and treatment of Madelung's disease].

OBJECTIVE: To review the characteristics of Madelung's disease which is rare and unfamiliar to clinicians and to find the method of diagnosis and treatment. METHODS: Detailed clinical data of 7 patients with Madelung's disease were reviewed and analyzed. And related literatures were discussed together. RESULTS: All of 7 patients have excessive subcutaneous fat deposit predominantly around neck. One patients had the complication of central and peripheral neuropathy, One patients had the complication of glucose intolerance, One patients had the complication of chronic hepatopathy and hyperuricaemia. These 3 patients were associated with sleep apnea syndrome simultaneously. Another one patient was accompanied by autonomic nervous system disease only. Total neck lipectomy and abstinence from alcohol were performed on 5 patients. No recurrence was seen during a follow-up of 6 months to 5 years. One patient received partial lipectomy twice and relapsed again. All pathological results were nonencapsulated fat. One patient refused treatment. Six men patients were alcohol abusers. CONCLUSIONS: Madelung's disease is characterized by massive accumulation of nonencapsulated subcutaneous fat mainly located symmetrically in the neck. Chronic alcoholism may be a major risk factor. It may be associated with some internal diseases. Total neck lipectomy to improve figuration and relieve pressure and abstinence from alcohol may be the main effective therapy.

Adult↗

PubMed1993

Experience with tumescent technique in lipoplasty.

Tumescent injection of tissues in preparation for suction lipectomy appears to be safe and effective. It allows lipoplasty of a wide range of volumes and areas in an office setting under oral sedation and without the need for fluid replacement. Few plastic surgeons believe this or have experience with the technique. This article documents the study of the characteristics of tumescent injection, demonstrates its effectiveness and utility, and addresses issues raised by those who doubt that this is a major improvement in accomplishing suction lipectomy. One hundred consecutive cases were treated over two and a half years without using any intravenous fluid or intravenous medication. Results of this survey are tabulated and discussed. They show the safety and advantages of this adjunct to lipoplasty.

Adolescent↗

PubMed1989

Contouring of the midtrunk in overweight patients.

Classical abdominoplasty primarily addresses the anterior abdominal wall. It involves a low transverse incision, extensive undermining in the supra-aponeurotic plane, correction of the musculofascial flaccidity, and resection of excessive skin and fat. The introduction of suction lipectomy into the armamentarium of the plastic surgeon has allowed a more thorough, yet safer, contouring of the entire midtrunk. When used in conjunction with a modified W-type abdominoplasty, circumferential suction lipectomy has yielded excellent results in contouring the midtrunk of overweight patients. It is the purpose of this article to present our technique for this procedure.

Abdomen↗

PubMed2003

[Surgical therapy of Madelung's disease in the head and neck area].

PATIENTS AND METHODS: Between 1995 and 2001 we treated 12 patients with benign symmetric lipomatosis in the head and neck. The group comprised 11 men and 1 woman aged 34-62 (M=47). The most frequent complaints were diminished range of motion of the head and obstruction when eating or speaking. Combined lipectomy and liposuction were performed in all patients, with liposuction being carried out in a second session. RESULTS: The mean follow-up period was 3 years. The functional results were very satisfactory in all patients. Of the 12 patients, 9 were also satisfied with the aesthetic outcome.A recurrence occurred in three patients 1.5, 2, or 3 years after the operation. Severe complications were not observed. CONCLUSIONS: According to our experience, combined lipectomy and liposuction represents a successful procedure in treating benign symmetric lipomatosis in the head and neck region.Nevertheless, advantages and drawbacks of the two techniques should be equally considered prior to surgery.

Adult↗

PubMedDate not supplied

Safe total corporal contouring with large-volume liposuction for the obese patient.

The advent of the tumescent technique in 1987 allowed for safe total corporal contouring as an ambulatory, single-session megaliposuction with the patient under regional anesthesia supplemented by local anesthetic only in selected areas. Safety and aesthetic issues define large-volume liposuction as having a 5,000-ml aspirate, mega-volume liposuction as having an 8,000-ml aspirate, and giganto-volume liposuction as having an aspirate of 12,000 ml or more. Clinically, a total volume comprising 5,000 ml of fat and wetting solution aspirated during the procedure qualifies for megaliposuction/large-volume liposuction. Between September 2000 and August 2005, 470 cases of liposuction were managed. In 296 (63%) of the 470 cases, the total volume of aspirate exceeded 5 l (range, 5,000-22,000 ml). Concurrent limited or total-block lipectomy was performed in 70 of 296 cases (23.6%). Regional anesthesia with conscious sedation was preferred, except where liposuction targeted areas above the subcostal region (the upper trunk, lateral chest, gynecomastia, breast, arms, and face), or when the patient so desired. Tumescent infiltration was achieved with hypotonic lactated Ringer's solution, adrenalin, triamcinalone, and hyalase in all cases during the last one year of the series. This approach has clinically shown less tissue edema in the postoperative period than with conventional physiologic saline used in place of the Ringer's lactate solution. The amount injected varied from 1,000 to 8,000 ml depending on the size, site, and area. Local anesthetic was included only for the terminal portion of the tumescent mixture, wherever the subcostal regions were infiltrated. The aspirate was restricted to the unstained white/yellow fat, and the amount of fat aspirated did not have any bearing on the amount of solution infiltrated. There were no major complications, and no blood transfusions were administered. The hospital stay ranged from 8 to 24 h for both liposuction and liposuction with a lipectomy. Serous discharge from access sites and serosanguinous fluid accumulation requiring drainage were necessitated in 32 of 296 cases (10.8%). Minor recontouring touch-ups were requested in 17 of 296 cases (5.7%). Early ambulation was encouraged for mobilization of third-space fluid shifts to expedite recovery and to prevent deep vein thrombosis. Follow-up evaluation ranged from 6 to 52 months, with 38 (12.8%) of 296 patients requesting further sessions for other new areas. Average weight reduction observed was 7 to 11.6 kg (approx. 4 to 10% of pre-operative body weight). Meticulous perioperative monitoring of systemic functions ensures safety in tumescent megaliposuction for the obese, and rewarding results are achieved in a single sitting.

Adipose Tissue↗

PubMedDate not supplied

Abdominal elephantiasis: a case report.

BACKGROUND: Elephantiasis is a well-known condition in dermatology usually affecting the legs and external genitalia. It is characterized by chronic inflammation and obstruction of the lymphatic channels and by hypertrophy of the skin and subcutaneous tissues. The etiology is either idiopathic or caused by a variety of conditions such as chronic filarial disease, leprosy, leishmaniasis, and chronic recurrent cellulites. OBJECTIVE: Elephantiasis of the abdominal wall is very rare. A complete review of the English and French literature showed only two cases reported in 1966 and 1973, respectively. We report a third case of abdominal elephantiasis and we briefly review this entity. METHODS: We present the case of a 51-year-old woman who had progressively developed an enormous pediculated abdominal mass hanging down her knees. The skin was thickened, hyperpigmented, and fissured. She had a history of multiple abdominal cellulites. RESULTS: She underwent an abdominal lipectomy. Histopathology of the specimen confirmed the diagnosis of abdominal elephantiasis. CONCLUSION: Abdominal elephantiasis is a rare disease that represents end-stage failure of lymph drainage. Lipectomy should be considered in the management of this condition.

Abdomen↗