Suction lipectomy (liposuction) is the most frequently performed esthetic procedure in the western world today; yet, there are no data to demonstrate that the regional removal of adipose tissue mass persists or that adipose tissue hypertrophy and/or hyperplasia does not occur after liposuction to defend body fat. We have published that by one yr., reduction at the lipectomized site occurs with variable increases in the circumference of non-lipectomized subcutaneous sites. Moreover, our unpublished data show that insulin sensitivity was inversely related to increases in circumference of both the lipectomized and non-lipectomized sites. Therefore, the goals of this study are to: 1) determine if suction lipectomy fails to modify regional and/or total body fat over 3 yr, 2) determine if the expression of genes of adipocyte differentiation and/or inflammation or fibrosis predict adipose tissue regional expression in the control and/or lipectomized site, and 3) assess novel adipose tissue genes that predict the response of regional adipose tissue to suction lipectomy. Men and women (n=54) will be randomly assigned to either a control or a surgery group. Lipectomized sites will include the abdomen for men and the hips and thighs for women. All eligible volunteers will complete body measurement visits at the beginning of the study and then at 6 wk and 6, 12, 24, and 36 mos. This visit will include ht, wt, and resting metabolic rate, and regional circumference (arms, thighs, waist, and hips), body fat composition (DEXA), and MRI (xiphoid to knees and upper arms) to determine fat distribution. All volunteers will also undergo a euglycemic clamp to assess insulin action at baseline, 6 wk, and 6 mo, as well as adipose tissue biopsies which will be analyzed for fat cell volume, genes related to regional inflammation and fibrosis and adipose tissue differentiation, and novel gene expression using DNA gene array technology. For those in the surgery group, suction lipectomy will be scheduled within 2 wk of the baseline measurements. Control subjects will be offered suction lipectomy at the end of the 3- yr study under the same protocol guidelines and benefits as those volunteers randomized to the surgery group. These studies will not only evaluate the efficacy of suction lipectomy and the genetic defense of body fat in humans, but may additionally provide insights into the regulation of regional adipose tissue distribution in humans.
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