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Background: Evidence suggesting that adipose tissue is a metabolically active tissue has generated debate on the effects of large-volume liposuction (LVL) on cardiovascular risk factors. The currently available data on the metabolic effects of LVL are inconsistent. The authors performed a systemic review to identify available evidence of the influence of LVL on cardiovascular risk factors.
Methods: A PubMed search using the terms “liposuction”, “suction”, “lipectomy”, “leptin”, “insulin”, “cardiac risk factor”, and “heart disease” was conducted. Articles were screened using predetermined inclusion and exclusion criteria. LVL was defined as greater than 4 liters of fat removal. All included studies had patients undergo pre- and post-operative evaluation of cardiovascular risk factors, inflammatory cytokines, and/or insulin resistance/sensitivity. Relevant studies were evaluated and assigned a level of evidence with the American Society of Plastic Surgeons Evidence Rating Scales. All data are expressed as mean + standard deviation.
Results: A total of nine studies that met the inclusion criteria were reviewed, of which one report was a continuation of previous study to evaluate long-term effects. All reports were prospective studies, of which six were case series, two were randomized-control studies, and one was a cohort study with aged-matched controls. A total of 196 obese patients (BMI > 30.0 kg/m2), 57 overweight patients (BMI > 25 kg/m2), and 8 normal weight patients (BMI < 24.9 kg/m2) were pooled for analysis with a mean BMI range of 23.7 to 39.9. Follow-up evaluation ranged from 3 weeks to 4 years, the mean volume of fat aspirated was 6.7+4.4 L, and the mean age ranged from 27.3 to 52 years. The mean BMI at baseline and post-liposuction was 31.6+3.2 and 29.7+3.1, respectively. Seven studies reported a decrease in total cholesterol levels with an overall mean reduction of -7.9+5.7 mg/dl. Four studies examined inflammatory cytokines including TNF-α, IL-6 and CRP and adipocytokines including leptin and adiponectin. Following LVL, TNF-α and leptin was reported to decrease in all four studies. Two studies reported a statistically significant decrease in all inflammatory cytokines with an increase in adiponectin following LVL. Only one study included participants with type 2 diabetes mellitus, whereas eight studies evaluated insulin sensitivity/resistance. Of these studies, six reported improvement in insulin sensitivity after LVL while two studies reported no change. One study found significant improvement in insulin sensitivity in nondiabetic patients. After designation of level of evidence, seven represented level IV and two represented level II evidence.
Conclusion: Liposuction is among the most common aesthetic surgical procedures performed in the United States. Advances in liposuction make it possible to remove considerable amount of adipose tissue. Current data, although conflicting, appear to support the notion that LVL can affect cardiovascular risk factors, metabolic balance, and insulin resistance. Therefore, LVL should not be dismissed as a purely aesthetic procedure. Future research is needed to clarify the role of LVL in improving overall health.