Women gain weight and fat mass despite lipectomy at abdominoplasty and breast reduction

doi:10.1530/EJE-07-0852

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Women gain weight and fat mass despite lipectomy at abdominoplasty and breast reduction

A S Rinomhota, D U S Bulugahapitiya¹, S J French², C M Caddy³, R W Griffiths³ and R J M Ross²

School of Healthcare, University of Leeds, Leeds, LS2 9JT UK^¹ Academic Unit of Diabetes, Endocrinology and Metabolism, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield, S10 2JF, UK^² MARS Confectionery, Sheffield, UK and ^³ Department of Plastic and Reconstructive Surgery, Northern General Hospital, Sheffield, S57 7AU UK

(Correspondence should be addressed to R J M Ross; Email: r.j.ross{at}sheffield.ac.uk)

Abstract

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Abstract
Introduction
Methods
Results
Discussion
References

Objectives: In animal models, fat removal results in compensatory weightgain. No study has reported measurement of weight followinglipectomy in humans. We have examined changes in weight in patientswho underwent lipectomy.

Methods: In a retrospective analysis, 16 patients who had abdominoplastyand 17 patients who underwent bilateral breast reduction werecompared with 16 patients who had carpal tunnel syndrome release.Following this, a prospective study was carried out on 7 subjectsawaiting abdominoplasty and 12 subjects awaiting bilateral breastreduction surgery.

Results: In the retrospective study, all three patient groups gainedweight following surgery. The abdominoplasty group was heavierbefore surgery and showed greatest weight gain but there wasno statistically significant difference in weight gain betweenthe groups. In the prospective study, the abdominoplasty grouphad a mean fat removal of 1.77 kg and breast reduction grouphad a mean of 3.22 kg. Eighteen months following surgery theabdominoplasty group showed a significant mean increase in bodyweight (mean increase: 4.82 kg) and body mass index (BMI) (meanincrease: 1.66 kg/m²). In the bilateral breast reduction group,there was a non-significant mean gain in weight (mean increase:0.67 kg) and BMI (mean increase: 0.21 kg/m²).

Conclusions: Patients undergoing lipectomy during abdominoplasty and bilateralbreast reduction will gain weight in the long term. This weightgain probably reflects the expected gain in weight without surgeryas a similar finding is observed in patients who have undergonesurgery without lipectomy. These results highlight the limitationof lipectomy as a weight control measure.

Introduction

Top
Abstract
Introduction
Methods
Results
Discussion
References

Change in weight has not been reported in women who have undergonesurgical removal of fat. In a review of 631 patients who underwentliposuction, it was reported that $~$ 80% were able to maintaina stable post-operative weight but no details of weight weregiven (1). Cardiovascular risk profile does not appear to improveafter liposuction (2, 3), although insulin sensitivity has beenreported to improve (4) but not in all studies (2). In animalmodels, the removal of fat results in compensatory weight gain(5, 6, 7, 8, 9). It has been suggested that this is mediatedby a blood-borne factor as serum from lipectomised rats stimulatedproliferation of pre-adipocytes in vitro (10), but intriguinglyfat transplantation does not appear to result in compensatoryfat loss (11). A questionnaire survey of patients who had undergoneblunt suction lipectomy suggested that in humans there is compensatorydevelopment of fatty tissue at non-treated locations althoughthese patients were not reviewed and no direct measurementswere taken by the researchers (12). Lipectomy surgery has beenperformed in humans over many years and it is surprising thatno study has reported on the relationship between lipectomyand body weight gain. We now report retrospective and prospectivestudies of weight change following lipectomy surgery.

Methods

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Abstract
Introduction
Methods
Results
Discussion
References

The study was approved by the North Sheffield Local Ethics Committeeand patients gave informed written consent.

Retrospective study

A retrospective study was performed in women aged 18–65years who had undergone surgery in the last 2 years for abdominoplasty(n=16), bilateral breast reduction (n=17) and carpal tunnelsyndrome release (n=16). The carpal tunnel syndrome releasegroup was the control group as they had no fat removed. Patients'details are shown in Table 1. Initial data were collected frompatients' medical records.

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Table 1 Group characteristics of the subjects in the retrospective study at pre-surgery and follow-up.

Consented patients were invited for follow-up and body weight,height measurements and body composition were recorded. Thebody weight was measured using a stand on digital electronicscale, height was measured using traditional stadiometer andbody composition was measured by bioelectrical impedance techniqueusing body stat 1500.

Prospective study

A prospective study was carried out on 19 healthy females aged18–59 years who were awaiting elective reconstructiveaesthetic surgery (Table 2). These subjects were either normalweight, overweight or obese. Out of these, 7 subjects had abdominoplastywhile 12 subjects had bilateral breast reduction. Patients ondrugs that can affect energy expenditure and patients with metabolicconditions such as diabetes, thyrotoxicosis and myxoedema wereexcluded. Patients were reviewed before surgery, 4 weeks aftersurgery and at the end of 18 months. On all three occasionsweight, height and body composition were measured.

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Table 2 Group characteristics of the subjects in the prospective study at pre-surgery and follow-up.

Data were analysed by SPSS version 10.0 Chicago, Illinois, USAfor Windows using ANOVA between groups with post hoc Bonferroniadjusted comparisons. Significance was accepted at the levelof 0.05%.

Results

Top
Abstract
Introduction
Methods
Results
Discussion
References

Retrospective study

All three groups in the retrospective study showed significantweight and body mass index (BMI) gain following surgery (Table 1,Fig. 1). The abdominoplasty group showed the largest mean weightgain (3.55±8.29 kg) when compared with the bilateralbreast reduction group (2.60±4.09 kg) and the controlgroup (2.66±2.84 kg), but there was no significant differencebetween the groups. The patients in the abdominoplasty grouphad significantly greater body weight pre-surgery and showedthe greatest changes in weight and BMI following surgery (Table 1).The abdominoplasty group showed a significantly greater fatmass (5.52%, P $≤$ 0.032) compared with the control group followinglipectomy.

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Figure 1 Mean weight change in abdominoplasty group, bilateral breast reduction group and carpal tunnel syndrome release group in the retrospective study at pre-surgery, at 1 month and 18 months following surgery respectively.

Prospective study

The abdominoplasty group had a significant increase in bodyweight and BMI during the 18-month study period following surgery(Table 2, Fig. 2). Mean weight gain for the abdominoplasty groupwas 4.28±4.34 kg. In the bilateral breast reduction group,pre-surgery to 18 months post-surgery there was a non-significantincrease in weight (mean weight gain 0.67±5.03 kg; Table 2,Fig. 2). In the abdominoplasty group, the change in body fatfrom pre-surgery to 18 months post-surgery was 7.94% and wasnot significant (P $≤$ 0.075). In the bilateral breast reductiongroup, pre-surgery to 18 months post-surgery the mean differencein body fat was 0.04% and was not significant (P $≤$ 0.909).

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Figure 2 Mean weight change in abdominoplasty group and bilateral breast reduction group in the prospective study at pre-surgery, at 1 month and 18 months following surgery respectively.

	Discussion

Top Abstract Introduction Methods Results Discussion References

The results of this study support observations in animal modelsthat lipectomy is followed by an increase in body fat and confirma questionnaire survey in humans that suggested weight gainfollowing liposuction (12). The patients undergoing abdominoplastywere heavier before surgery and this may account for their greaterincrease in weight and BMI. It may be that the pre-surgery weightis an important factor in determining weight gain followingsurgery although this was not addressed in our study. It ispossible that the energy regulatory mechanisms of the body actto prevent weight loss in individuals with abdominal obesityor visceral fatty content (13, 14). The larger but non-significantincrease in body fat in abdominoplasty group compared with bilateralbreast reduction group suggests that there may be differencesin the regulatory mechanisms that depend upon the depot of fatremoved. Of relevance, femoral adipocytes from women have beenshown to have a greater lipoprotein lipase activity than abdominalor mammary adipocytes and the difference in fat depot may beregulated by oestrogen levels (15). In addition, a variety ofmetabolic differences have been reported in rodents betweenmammary and abdominal fat (16).

The lack of statistical significant difference in body weightchanges between the bilateral breast reduction group and thecarpal tunnel syndrome group suggests that most individualsin the two groups had similar characteristics or that the twogroups as a whole were very similar in terms of body weightgain and BMI changes. Pernia et al. (17) found a higher prevalenceof carpal tunnel syndrome in women who had been admitted tohospital for breast reduction than in those with smaller breastsand they concluded that breast size was a significant predictorof carpal tunnel syndrome. They argued that women who had mammaryhypertrophy had an increased risk of carpal tunnel syndrome.It is known that some diseases such as hypothyroidism, diabetesmellitus, wrist osteoarthritis and obesity are associated withcarpal tunnel syndrome (18).

In our prospective study, weight increase was seen in both theabdominoplasty and bilateral breast reduction groups. However,higher weight gain was seen with the abdominoplasty group possiblyreflecting previous weight history. Previous studies and oursdid not address lifestyle changes. Changes in dietary intakeand exercise could influence the metabolic response to surgeryand this should be addressed in future studies.

Our results suggest that lipectomy was of limited value in bodyweight control since weight gain was observed following theseprocedures. This weight gain probably reflects the expectedgain in weight without surgery as a similar finding is observedin patients who have undergone surgery without lipectomy. Therefore,these results highlight the limitation of this procedure asa weight control measure. Further prospective studies are requiredwith control groups that match weight and BMI to confirm theabove findings.

Acknowledgements

Our sincere thanks go to patients and other volunteers who agreedto help and for their cooperation with the protocols. Also,we would like to acknowledge the Faculty of Medicine ResearchCommittee, University of Leeds for the financial support formost of the work. Our thanks extend to the Ministry of Healthand the Post-graduate Institute of Medicine, Sri Lanka. A SRinomhota and D U S Bulugahapitiya contributed equally to thiswork.