Structural and Functional Properties of Deep Abdominal Subcutaneous Adipose Tissue Explain Its Association With Insulin Resistance and Cardiovascular Risk in Men Subcutaneous adipose tissue remodeling during the initial phase of weight gain induced by overfeeding in humans. Effects of sex on the change in visceral, subcutaneous adipose tissue and skeletal muscle in response to weight loss Liposuction induces a compensatory increase of visceral fat which is effectively counteracted by physical activity: a randomized trial. Comparison of closure of subcutaneous tissue versus non-closure in relation to wound disruption after abdominal hysterectomy in obese patients. Women gain weight and fat mass despite lipectomy at abdominoplasty and breast reduction. The effects of the surgical removal of subcutaneous adipose tissue on energy expenditure and adipocytokine concentrations in obese women. Mobilization of visceral and subcutaneous adipose tissue in response to energy restriction and exercise. Effect of Surgically Removing Subcutaneous Fat by Abdominoplasty on Leptin Concentrations and Insulin Sensitivity Modification of subcutaneous adipose tissue by a methylxanthine formulation: a double-blind controlled study. Fast adipose tissue (FAT) assessment by MRI. The Effectiveness and Safety of Combining Laser-Assisted Liposuction and Abdominoplasty Fat redistribution following suction lipectomy: defense of body fat and patterns of restoration. Photographic Measurements in 301 Cases of Liposuction and Abdominoplasty Reveal Fat Reduction without Redistribution Epicardial and Pericardial Fat in Type 2 Diabetes: Favourable Effects of Biliopancreatic Diversion Prospective Clinical Study Reveals Significant Reduction in Triglyceride Level and White Blood Cell Count after Liposuction and Abdominoplasty and No Change in Cholesterol Levels Quantitative measures of visceral adiposity and body mass index in predicting rectal cancer outcomes after neoadjuvant chemoradiation.
OBJECTIVE Fat distribution is an important variable explaining metabolic heterogeneity of obesity . Abdominal subcutaneous adipose tissue ( SAT ) is divided by the Scarpa ’s fascia into a deep subcutaneous adipose tissue ( dSAT ) and a superficial subcutaneous adipose tissue ( sSAT ) layer . This study sought to characterize functional differences between the two SAT layers to explore their relative contribution to metabolic traits and cardiovascular risk ( CVR ) profile . RESEARCH DESIGN AND METHODS We recruited 371 Caucasians consecutively from a local r and om , population -based screening project in Oxford and 25 Asian Indians from the local community . The depth of the SAT layers was determined by ultrasound ( US ) , and adipose tissue ( AT ) biopsies were performed under US guidance in a subgroup of 43 Caucasians .  Visceral adipose tissue ( VAT ) mass was quantified by dual-energy X-ray absorptiometry scan . RESULTS Male adiposity in both ethnic groups was characterized by a disproportionate expansion of dSAT , which was strongly correlated with VAT mass . dSAT depth was a strong predictor of global insulin resistance ( IR ; homeostatic model assessment of IR ) , liver-specific IR ( insulin-like growth factor binding protein-1 ) , and Framingham risk score independently of other measures of adiposity in men . Moreover , dSAT had higher expression of proinflammatory , lipogenic , and lipolytic genes and contained higher proportions of saturated fatty acids . There was increased proportion of small adipocytes in dSAT . CONCLUSIONS SAT is heterogeneous ; dSAT exp and s disproportionally more than sSAT with increasing obesity in Caucasian males ( confirmed also in Asian Indians ) . Its expansion is related to increased CVR independent of other adiposity measures , and it has biological properties suggestive of higher metabolic activity contributing to global IR CONTEXT Deciphering the early processes occurring in adipose tissue during weight gain is a major issue for underst and ing the development of fat mass and obesity . Experimental overfeeding in humans is a unique situation to tackle these events . OBJECTIVE Our aim was to identify the pathways involved in sc adipose tissue remodeling during the initial phase of weight gain . RESEARCH DESIGN AND METHODS Forty-four healthy men were involved in an overfeeding protocol with a lipid-enriched diet ( + 760 kcal/d ) for 2 months .  Subcutaneous abdominal adipose tissue biopsies were taken for histology , transcriptomics , and Western blotting in the basal state , after 14 d , and at the end of the protocol . RESULTS Overfeeding significantly increased body weight ( + 2.5 kg ) and fat mass . Reorganization of gene expression patterns occurred in adipose tissue with an up-regulation of numerous genes involved in lipid metabolism and storage , followed by clusters of genes related to angiogenesis and extracellular matrix remodeling . Histological examination showed increased microvascular density and connective tissue deposition after 56 d of overfeeding , with no changes in the number of macrophages or inflammatory cells . Inhibition of the canonical Wnt/β-catenin signaling pathway and induction of the renin-angiotensin system might be implicated in the remodeling of sc adipose tissue . CONCLUSIONS We characterize the coordinated and time-dependent processes that occur in human adipose tissue during the early phase of weight gain in healthy subjects and identify pathways representing potential targets in pathologies of adipose development , including obesity OBJECTIVE : To examine the influence of sex on whole body and regional subcutaneous , visceral , total adipose tissue ( AT ) , skeletal muscle ( SM ) , and lean tissue in response to weight loss induced by diet alone ( DO ) or the combination of diet and aerobic ( DA ) or resistance exercise ( DR ) . DESIGN : Sixty upper‐body obese men and women were r and omly assigned to one of three treatments : DO , DA , or DR . All tissues were measured using a whole body , magnetic resonance imaging protocol . RESULTS : Within each group reductions were observed for body weight ( ~11 kg ) , subcutaneous and visceral AT ( P<0.01 ) . After controlling for pretreatment differences in tissue size , reductions in total adiposity , total and regional subcutaneous and visceral adipose tissue were not different between sexes ( P>0.1 ) . Independent of sex , the reduction in visceral AT was greater than subcutaneous AT ( P<0.05 ) in response to DO and DA . With the exception of DA women , the reduction in abdominal subcutaneous AT was greater ( P<0.05 ) than lower‐body subcutaneous AT in response to diet and exercise , but not diet alone , in both sexes ( P>0.05 ) . Independent of sex , skeletal muscle mass was preserved within the exercise groups ( P>0.05 ) but not diet alone ( P<0.05 ) . Peak VO2 ( l/min ) improved in the DA groups as did muscular strength in the DR groups ( P<0.01 ) . CONCLUSIONS : These findings indicate that in response to diet or diet and exercise‐induced weight loss , reductions in total adiposity , subcutaneous and visceral adipose tissue distribution are not different in obese men and women . Independent of sex , the combination of diet and exercise results in a preservation of skeletal muscle mass , a preferential reduction of abdominal subcutaneous AT , and improved functional capacity by comparison to diet alone CONTEXT Liposuction is suggested to result in long-term body fat regain that could lead to increased cardiometabolic risk . We hypothesized that physical activity could prevent this effect . OBJECTIVE Our objective was to investigate the effects of liposuction on body fat distribution and cardiometabolic risk factors in women who were either exercise trained or not after surgery . DESIGN , SETTING , AND PARTICIPANTS Thirty-six healthy normal-weight women participated in this 6-month r and omized controlled trial at the University of Sao Paulo , Sao Paulo , Brazil . INTERVENTIONS Patients underwent a small-volume abdominal liposuction . Two months after surgery , the subjects were r and omly allocated into two groups : trained ( TR , n = 18 , 4-month exercise program ) and nontrained ( NT , n = 18 ) . MAIN OUTCOME MEASURES Body fat distribution ( assessed by computed tomography ) was assessed before the intervention ( PRE ) and 2 months ( POST2 ) , and 6 months ( POST6 ) after surgery . Secondary outcome measures included body composition , metabolic parameters and dietary intake , assessed at PRE , POST2 , and POST6 , and total energy expenditure , physical capacity , and sc adipocyte size and lipid metabolism-related gene expression , assessed at PRE and POST6 . RESULTS Liposuction was effective in reducing sc abdominal fat ( PRE vs. POST2 , P = 0.0001 ) . Despite the sustained sc abdominal fat decrement at POST6 ( P = 0.0001 ) , the NT group showed a significant 10 % increase in visceral fat from PRE to POST6 ( P = 0.04 ; effect size = -0.72 ) and decreased energy expenditure ( P = 0.01 ; effect size = 0.95 ) when compared with TR . Dietary intake , adipocyte size , and gene expression were unchanged over time . CONCLUSION Abdominal liposuction does not induce regrowth of fat , but it does trigger a compensatory increase of visceral fat , which is effectively counteracted by physical activity AIMS To evaluate the role of subcutaneous tissue closure in relation to wound disruption after abdominal hysterectomy in obese patients . MATERIAL AND METHODS In a prospect i ve study at a tertiary referral centre in Mumbai , India , 60 obese patients with subcutaneous fat more than 2.5 cms were included in the study . In 30 patients , subcutaneous tissue was closed using synthetic suture ( dexon ) while in 30 control patients subcutaneous tissue was not closed .  Average weight in the study and control groups were 69 -/+ 9.2 kg and 63.3 -/+ 11.2 kg respectively . RESULTS The wound disruption occurred in 5 patients in non-closure group as compared to only one in the closure group . Incidence of seroma , haematoma formation and other wound complications were higher in the non-closure group . CONCLUSIONS Closure of the subcutaneous tissue after abdominal hysterectomy of women with at least 2.5 cms of subcutaneous tissue lowers the overall rate of complications leading to disruption of the incision OBJECTIVES In animal models , fat removal results in compensatory weight gain . No study has reported measurement of weight following lipectomy in humans . We have examined changes in weight in patients who underwent lipectomy .  METHODS In a retrospective analysis , 16 patients who had abdominoplasty and 17 patients who underwent bilateral breast reduction were compared with 16 patients who had carpal tunnel syndrome release . Following this , a prospect i ve study was carried out on 7 subjects awaiting abdominoplasty and 12 subjects awaiting bilateral breast reduction surgery .  RESULTS In the retrospective study , all three patient groups gained weight following surgery . The abdominoplasty group was heavier before surgery and showed greatest weight gain but there was no statistically significant difference in weight gain between the groups . In the prospect i ve study , the abdominoplasty group had a mean fat removal of 1.77 kg and breast reduction group had a mean of 3.22 kg . Eighteen months following surgery the abdominoplasty group showed a significant mean increase in body weight ( mean increase : 4.82 kg ) and body mass index ( BMI ) ( mean increase : 1.66 kg/m(2 ) ) . 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/m(2 ) ) . CONCLUSIONS Patients undergoing lipectomy during abdominoplasty and bilateral breast reduction will gain weight in the long term . This weight gain probably reflects the expected gain in weight without surgery as a similar finding is observed in patients who have undergone surgery without lipectomy  . These results highlight the limitation of lipectomy as a weight control measure OBJECTIVE To analyze the effects of the surgical removal of subcutaneous adipose tissue by ultrasound-assisted megalipoplasty ( UAM ) on energy expenditure and adipocytokine concentrations in obese women . METHODS Fifteen premenopausal obese women with BMI 37.5+/-6.3 kg/m(2 ) ( range : 30.7 - 53.6 kg/m(2 ) ) underwent UAM .  Body composition ( by DEXA ) , resting metabolic rate ( REE ) by indirect calorimetry , insulin resistance ( by the HOMA method ) , leptin , C-reactive protein , interleukin-6 , resistin and adiponectin were measured before and 1 , 3 , 28 and 180 days after the procedure . RESULTS UAM significantly reduced fat mass at day 3 , without further changes in the following days . REE increased at day 3 after UAM , returned to baseline levels at day 28 and significantly declined at day 180 . Leptin levels transiently increased after UAM and then declined according to fat mass reduction . C-reactive protein , interleukin-6 and resistin levels acutely increased after UAM and then returned to the baseline levels . Adiponectin levels acutely declined after the procedure and then stabilized to a plasma level slightly lower than at baseline . Insulin resistance deteriorated in the acute post-operative phase and then improved . CONCLUSION The surgical removal of subcutaneous fat was associated to an acute inflammatory reaction with high REE and insulin-resistance . Later on , the metabolic effects of fat mass removal appeared , with a reduction of leptin levels and REE and an improvement of insulin resistance The effects of energy restriction ( diet ) in combination with either aerobic ( DA ) or resistance exercise ( DR ) on adipose tissue ( AT ) distribution were evaluated in 24 obese women ( DA , n = 10 ; DR , n = 14 ) . AT distribution was measured by magnetic resonance imaging ( MRI ) . Comparison between groups demonstrated that the relative losses observed for body weight , subcutaneous AT ( SAT ) , and visceral AT ( VAT ) volume were not significantly different ( P > 0.05 ) . A significant reduction in the volume ratio of VAT to SAT was observed for both groups ( P < 0.01 ) . Comparison of arm , abdomen and torso , and lower-body regions revealed that the regional mobilization of SAT was not significantly different between groups ( P > 0.05 ) and that for both groups there was a preferential mobilization of SAT from the abdominal region ( P < 0.05 ) . Within the VAT depot , significant reductions were observed for both intraperitoneal and extraperitoneal AT ( P < 0.01 ) . These findings suggest that the combination of moderate energy restriction and either resistance or aerobic exercise induces significant reductions in VAT and SAT , with a preferential loss of VAT , and are thus effective means of reducing total and upper-body obesity in obese women The aim of this study was to identify the effect of surgically removing subcutaneous fat by abdominoplasty on leptin concentrations and insulin sensitivity . An open clinical trial with a noninterventional parallel group was carried out in 12 obese women . After r and omization , 6 volunteers were selected for abdominoplasty  , and the other 6 women were considered as the noninterventional group . A metabolic profile , including leptin concentrations , and insulin tolerance test to assess insulin sensitivity were performed on all volunteers before intervention or nonintervention and 40–50 days afterward . A significant reduction in body mass index ( 30.7 ± 0.9 versus 29.6 ± 0.7 kg/m2 ; P = 0.02 ) and in leptin concentrations ( 41.3 ± 10.6 versus 32.0 ± 10.2 ng/mL ; P = 0.02 ) was observed after abdominoplasty . Insulin sensitivity did not change after intervention . In conclusion , surgically removing subcutaneous fat by abdominoplasty  decreased leptin concentrations , with no change in insulin sensitivity BACKGROUND Excessive subcutaneous adipose tissue is typically treated by physically removing the fat through liposuction , but cost and accessibility have popularized alternative treatments for reducing adipose tissue thickness . OBJECTIVE The purpose of this study was to test the absolute and relative effectiveness of a liposome-encapsulated caffeine-based cream in modifying subcutaneous adipose tissue . METHODS Forty-one patients consented and completed the double-blind , single-center , placebo-controlled study . Caliper measurements , tape measurements , and photographs were taken over a 2-month period . RESULTS Both concentrations of the cream were found to significantly reduce the thickness of the adipose tissue in all areas of the body . In addition , the more concentrated cream was significantly more effective than the less concentrated cream in the areas of the hips and the triceps . CONCLUSION The caffeine-based liposome-encapsulated cream significantly reduced the thickness of the subcutaneous fat over a 2-month period We report a method of fast adipose tissue ( FAT ) assessment to characterize the quantity , and distribution of abdominal adipose tissue . Whole-volume coverage of the abdomen was obtained using 31 contiguous transverse T(1)-weighted images from 16 obese females . A radiologist manually traced all adipose tissue volumes in the images , while a physiologist used an automated method to measure adipose tissue in a single image at the level of the umbilicus . Automated analysis of the umbilicus-level image was significantly correlated with values obtained by manual analysis of the entire abdomen ( p < 0 . 001 ) . There was good agreement between the automated umbilicus-level image method and the manual whole abdomen method for subcutaneous adipose tissue ( r(2 ) = 0.958 ) , visceral adipose tissue ( r(2 ) = 0 . 753 ) , and total adipose tissue ( r(2 ) = 0.941 ) . The automated method required 6 min vs 2 h for the manual method Background Lipoabdominoplasty is nearly a daily aesthetic procedure . Despite the emergence of laser-assisted liposuction , to date , it has not been clearly evaluated combined with abdominoplasty . This prospect i ve study aim ed to evaluate the effectiveness and safety of laser-assisted liposuction relative to traditional liposuction combined with high-lateral-tension abdominoplasty . Methods This study investigated 36 consecutive female patients who underwent high-lateral-tension abdominoplasty combined with liposuction of the upper central abdomen and both flanks . The patients were divided into three equal groups based on the technique used for liposuction . Group 1 underwent conventional liposuction with abdominoplasty . Group 2 underwent a mixture of conventional and laser-assisted liposuction with abdominoplasty . Group 3 underwent laser-assisted liposuction with abdominoplasty . Results The patients in groups 2 and 3 had a better aesthetic outcome than those in group 1 with regard to abdominal contour and skin tightness . No major complications were observed in groups 1 and 2 . The patients in group 3 had a higher incidence of complications ( 3 seromas , 3 central necroses and dehiscence ) , and one patient underwent secondary sutures . Conclusion Laser-assisted liposuction combined with abdominoplasty in the lateral abdomen seems to be a safe technique with good aesthetic outcomes . Although the combined use of laser-assisted liposuction in the lateral and central abdomen can achieve relatively better aesthetic results , it is associated with significant complications , and its use can not be supported . Proper laser parameters in the central abdominal area still need further study .Level of Evidence IVThis journal requires that authors assign a level of evidence to each article . For a full description of these Evidence -Based Medicine ratings , please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 No r and omized studies in humans have examined whether fat returns after removal or where it returns . We undertook a prospect i ve , r and omized-controlled trial of  suction lipectomy in nonobese women to determine if adipose tissue ( AT ) is defended and if so , the anatomic pattern of redistribution . Healthy women with disproportionate AT depots ( lower abdomen , hips , or thighs ) were enrolled . Baseline body composition measurements included dual-energy X-ray absorptiometry ( DXA ) ( a priori primary outcome ) , abdominal/limb circumferences , subcutaneous skinfold thickness , and magnetic resonance imaging ( MRI ) ( torso/thighs ) . Participants ( n = 32 ; 36 ± 1 year ) were r and omized to small-volume liposuction ( n = 14 , mean BMI : 24 ± 2 kg/m(2 ) ) or control ( n=18 , mean BMI : 25 ± 2 ) following baseline . Surgery group participants underwent liposuction within 2 - 4 weeks . Identical measurements were repeated at 6 weeks , 6 months , and 1 year later . Participants agreed not to make lifestyle changes while enrolled . Between-group differences were adjusted for baseline level of the outcome variable . After 6 weeks , percent body fat ( % BF ) by DXA was decreased by 2.1 % in the lipectomy group and by 0.28 % in the control group ( adjusted difference ( AD ) : -1.82 % ; 95 % confidence interval ( CI ) : -2.79 % to -0.85 % ; P = 0.0002 ) . This difference was smaller at 6 months , and by 1 year was no longer significant ( 0.59 % ( control ) vs. -0.41 % ( lipectomy ) ; AD : -1.00 % ; CI : -2.65 to 0.64 ; P = 0.23 ) . AT reaccumulated differently across various sites . After 1 year the thigh region remained reduced ( 0.77 % ( control ) vs. -1.83 % ( lipectomy ) ; AD : -2.59 % ; CI : -3.91 to -1.28 ; P = 0.0001 ) , but AT reaccumulated in the abdominal region ( 0.64 % ( control ) vs. 0.42 % ( lipectomy ) ; AD : -0.22 ; CI : -2.35 to 1.91 ; P = 0.84 ) . Following suction lipectomy , BF was restored and redistributed from the thigh to the abdomen Background : There are no published studies of liposuction or abdominoplasty in a large number of patients using measurements of body dimensions . In the absence of rigorous data , some investigators have proposed that fat returns after liposuction . Methods : A prospect i ve study was undertaken among predominantly nonobese consecutive patients undergoing 301 liposuction and abdominoplasty procedures meeting the study criteria ( inclusion rate , 70.7 percent ) .  Lower body dimensions were measured using st and ardized photographs taken before and at least 3 months after surgery . Upper body measurements were compared between women who underwent simultaneous cosmetic breast surgery ( n = 67 ) and a group of women who had breast surgery alone ( n = 78 ) to investigate the possibility of fat redistribution . Results : The average weight change was a loss of 2.2 lbs after lower body liposuction ( p < 0.01 ) and 4.6 lbs when combined with abdominoplasty ( p < 0.001 ) . Liposuction significantly reduced abdominal , thigh , knee , and arm width ( p < 0.001 ) . Midabdominal and hip width were more effectively reduced by lipoabdominoplasty than liposuction alone ( p < 0.001 ) . There was no difference in upper body measurements when comparing patients who had simultaneous liposuction and /or abdominoplasty with patients who had cosmetic breast surgery alone . Measurements in patients with at least 1 year of follow-up ( n = 46 ) showed no evidence of fat reaccumulation . Conclusions : Both liposuction and abdominoplasty are valid techniques for long-term fat reduction and improvement of body proportions . There is no evidence of fat regrowth . CLINICAL QUESTION /LEVEL OF EVIDENCE : Therapeutic , III Purpose Ectopic fat is often identified in obese subjects who are susceptible to the development of type 2 diabetes mellitus ( T2DM ) . The ectopic fat favours the decrease in insulin sensitivity ( IS ) and adiponectin levels . We aim ed to evaluate the effect of biliopancreatic diversion ( BPD ) on the accumulation of ectopic fat , adiponectin levels and IS in obese with T2DM . Material s and Methods A nonr and omised controlled study was performed on sixty-eight women : 19 lean-control ( 23.0 ± 2.2 kg/m2 ) and 18 obese-control ( 35.0 ± 4.8 kg/m2 ) with normal glucose tolerance and 31 obese with T2DM ( 36.3 ± 3.7 kg/m2 ) . Of the 31 diabetic women , 20 underwent BPD and were reassessed 1 month and 12 months after surgery . The subcutaneous adipose tissue , visceral adipose tissue , epicardial adipose tissue and pericardial adipose tissue were evaluated by ultrasonography . The IS was assessed by a hyperglycaemic clamp , applying the minimal model of glucose . Results One month after surgery , there was a reduction in visceral and subcutaneous adipose tissues , whereas epicardial and pericardial adipose tissues exhibited significant reduction at the 12-month assessment ( p < 0.01 ) . Adiponectin levels and IS were normalised 1 month after surgery , resembling lean-control values and elevated above the obese-control values ( p < 0.01 ) . After 12 months , the improvement in IS and adiponectin was maintained , and 17 of the 20 operated patients exhibited fasting glucose and glycated haemoglobin within the normal range . Conclusions After BPD , positive physiological adaptations occurred in grade I and II obese patients with T2DM . These adaptations relate to the restoration of IS and decreased adiposopathy and explain the acute ( 1 month ) and chronic ( 12 months ) improvements in the glycaemic control Background : Triglyceride levels of 150 mg/dL or greater are known to be associated with an increased cardiovascular risk and metabolic syndrome . This study investigated the effect of liposuction and abdominoplasty on lipid levels , complete blood count , and other parameters . Methods : A prospect i ve study was undertaken among 322 consecutive patients ( 270 women and 52 men ) who presented for liposuction ( n = 229 ) , abdominoplasty with liposuction ( n = 87 ) , and abdominoplasty without liposuction ( n = 6 ) . The mean body mass index was 26.6 kg/m2 ( range , 18.6 to 44.1 kg/m2 ) . Ultrasonic liposuction using a superwet infusion technique was used in all cases , usually treating the lower body in women ( 64.4 percent ) and the trunk in men ( 86.5 percent ) . Results : Mean weight loss 3 months after liposuction was 2.2 lbs for liposuction alone ( p < 0.001 ) and 4.2 lbs for liposuction and abdominoplasty ( p < 0.05 ) . Mean fasting triglyceride level decreased 25.7 percent after liposuction ( p < 0.001 ) . The triglyceride level decreased 43.0 percent ( n = 56 , p < 0.001 ) after liposuction in patients with preoperative levels of 150 mg/dl or greater . There was a significant decrease in white cell count after both liposuction and liposuction/abdominoplasty ( p < 0.001 ) . There were no significant changes in total , low-density lipoprotein , or high-density lipoprotein cholesterol . Fasting glucose was unchanged . Conclusions : A significant ( p < 0.001 ) reduction in triglyceride level in patients with elevated preoperative levels and a significant decrease in leukocyte count ( p < 0.001 ) are favorable metabolic effects of liposuction and liposuction/abdominoplasty . Cholesterol levels are unaffected . CLINICAL QUESTION /LEVEL OF EVIDENCE : Therapeutic , IV BACKGROUND The association between body mass index as a measure of obesity and rectal cancer outcomes has been inconsistent . Radiologic measures of visceral adiposity using CT scans have not been well characterized among rectal cancer patients . The objective of this study was to examine quantitative radiologic measures of visceral obesity compared with body mass index in predicting patient outcomes among patients undergoing neoadjuvant chemoradiation and resection for locally advanced rectal cancers . STUDY DESIGN We identified 99 rectal adenocarcinoma patients treated with neoadjuvant chemoradiation and surgical resection .  Visceral and subcutaneous fat areas , as well as perinephric fat thickness ( PNF ) , were recorded and categorized as obese ( body mass index ≥30 , visceral fat area to subcutaneous fat area ratio [ V/S ] ≥0.4 , or median PNF ) . The Kaplan-Meier method , log-rank test , and Cox proportional hazards models evaluated overall and disease-free survival differences by adiposity . RESULTS Viscerally obese rectal cancer patients ( V/S > 0.4 or PNF ) were more likely to be older , male , and have pre-existing obesity-related conditions ( eg , diabetes , hypertension , and /or hypercholesterolemia ) . Elevated V/S or PNF was associated with shorter disease-free survival ( p = 0.02 ) or overall survival time ( p = 0.047 ) , respectively . Among patients with well to moderately differentiated tumors , visceral obesity was associated with poorer disease-free survival ( V/S > 0.4 : adjusted hazard ratio = 5.0 ; 95 % CI , 1.2 - 22.0 ) . CONCLUSIONS Visceral fat area to subcutaneous fat area ratio and PNF were strongly associated with key preoperative metabolic comorbidities , and body mass index was not . Findings suggests that elevated visceral adiposity was associated with an increased risk of recurrence , which was most evident among patients with well to moderately differentiated tumors and those with incomplete response to neoadjuvant chemoradiation treatment . Quantitative measures of visceral adiposity warrant large-scale prospect i ve evaluation
These results corroborate the evidence from experimental and clinical studies , which support fat redistribution and compensatory fat growth , as a result of feedback mechanisms , triggered by fat removal .
Adipose tissue is considered as an endocrine organ , which is developed in specific depots , distinguished either as subcutaneous or visceral .
Lipectomy , by means of liposuction or abdominoplasty , is a common plastic surgery procedure , which can remove substantial amounts of subcutaneous fat .
This systematic review aims to evaluate the impact of surgical removal of abdominal subcutaneous adipose tissue on  body weight and fat mass in females in the short- and long-term .