The Myth of Fat Redistribution

  • Eric Swanson


Some investigators believe that fat returns after liposuction. To evaluate this possibility, the author undertook a prospective study among predominantly nonobese consecutive patients undergoing 301 liposuction and abdominoplasty procedures. Lower body dimensions were measured using standardized photographs taken before and at least 3 months after surgery.

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 liposuction and abdominoplasty 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 re-accumulation. Both liposuction and abdominoplasty are valid techniques for long-term fat reduction and improvement of body proportions. There is no evidence of fat regrowth.

Similarly, some investigators suggest that liposuction may cause breast enlargement. To evaluate the possibility of secondary breast hypertrophy and fat redistribution after liposuction, 82 women were enrolled in a prospective controlled study. No significant increases in upper pole projection, breast projection, or breast area were found in patients treated with liposuction alone and those who received liposuction plus abdominoplasty. Neither liposuction nor abdominoplasty produces secondary breast enlargement.


Liposuction Abdominoplasty Redistribution Fat Measurements Photographic Reduction Body Proportions 


  1. 1.
    Swanson E. Assessment of reduction in subcutaneous fat thickness after liposuction using magnetic resonance imaging. J Plast Reconstr Aesthet Surg. 2012;65:128–30.CrossRefPubMedGoogle Scholar
  2. 2.
    Broughton G, Horton B, Lipschitz A, Kenkel JM, Brown SA, Rohrich RJ. Lifestyle outcomes, satisfaction, and attitudes of patients after liposuction: a Dallas experience. Plast Reconstr Surg. 2006;117:1738–49.CrossRefPubMedGoogle Scholar
  3. 3.
    Swanson E. Prospective outcome study of 360 patients treated with liposuction, lipoabdominoplasty, and abdominoplasty. Plast Reconstr Surg. 2012;129:965–78. discussion 979–980CrossRefPubMedGoogle Scholar
  4. 4.
    Swanson E. Photographic measurements in 301 cases of liposuction and abdominoplasty reveal fat reduction without redistribution. Plast Reconstr Surg. 2012;130:311e–22e. discussion 323e–324eCrossRefPubMedGoogle Scholar
  5. 5.
    Dillerud E, Håheim LL. Long-term results of blunt suction lipectomy assessed by a patient questionnaire survey. Plast Reconstr Surg. 1993;92:35–42.CrossRefPubMedGoogle Scholar
  6. 6.
    Hernandez TL, Kittelson JM, Law CK, et al. Fat redistribution following suction lipectomy: defense of body fat and patterns of restoration. Obesity. 2011;19:1388–95.CrossRefPubMedGoogle Scholar
  7. 7.
    Kolata G. With liposuction, the belly finds what the thighs lose. NY Times, 30 Apr 2011: Accessed 4 Sept 2017.
  8. 8.
    Paddock C. Fat liposuctioned From hips returns to belly within 12 months. Medical News Today, 2 May 2011. Accessed 4 Sept 2011.
  9. 9.
    Doheny K. Study: fat may return after liposuction. WebMD, 3 May 2011. Accessed 4 Sept 2011.
  10. 10.
    Bisaccia E, Scarborough DA. Breast enlargement after liposuction. Am J Cosmetic Surg. 1990;7:97–9.CrossRefGoogle Scholar
  11. 11.
    Scarborough DA, Bisaccia E. The occurrence of breast enlargement in females following liposuction. Am J Cosmetic Surg. 1991;8:97–102.CrossRefGoogle Scholar
  12. 12.
    Yun PL, Bruck M, Felsenfeld L, Katz BE. Breast enlargement after power liposuction: a retrospective review. Dermatol Surg. 2003;29:165–7.PubMedGoogle Scholar
  13. 13.
    Finzi E. Breast enlargement induced by liposuction. Dermatol Surg. 2003;29:928–30.PubMedGoogle Scholar
  14. 14.
    Frew KE, Rossi A, Bruck MC, Katz BE, Narins RS. Breast enlargement after liposuction: comparison of incidence between power liposuction versus traditional liposuction. Dermatol Surg. 2005;31:292–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Van der Lei B, Halbesma G-J, van Nieuwenhoven CA, van Wingerden JJ. Spontaneous breast enlargement following liposuction of the abdominal wall: does a link exist? Plast Reconstr Surg. 2007;119:1584–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Swanson E. No increase in female breast size or fat redistribution to the upper body after liposuction: a prospective controlled photometric study. Aesthet Surg J. 2014;34:896–906.CrossRefPubMedGoogle Scholar
  17. 17.
    DiBernardo BE, Adams RL, Krause J, Fiorillo MA, Gheradini G. Photographic standards in plastic surgery. Plast Reconstr Surg. 1998;102:559–68.CrossRefPubMedGoogle Scholar
  18. 18.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010;303(3):235–41.CrossRefPubMedGoogle Scholar
  19. 19.
    Yost TJ, Rodgers CM, Eckel RH. Suction lipectomy: outcome relates to region-specific lipoprotein lipase activity and interval weight change. Plast Reconstr Surg. 1993;92:1101–8. discussion 1109–1111CrossRefPubMedGoogle Scholar
  20. 20.
    Kuhns LR, Borlaza GS, Seigel R, Thornbury JR. External anatomic landmarks of the abdomen related to vertebral segments: applications in cross-sectional imaging. Am J Roentgenol. 1978;131:115–7.CrossRefGoogle Scholar
  21. 21.
    Rosenbaum M, Leibel RL, Hirsch J. Obesity. N Engl J Med. 1997;337:396–407.CrossRefPubMedGoogle Scholar
  22. 22.
    Spalding KL, Arner K, Westermark PO, et al. Dynamics of fat cell turnover in humans. Nature. 2008;453:783–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Hirsch J, Gallian E. Methods for the determination of adipose cell size in man and animals. J Lipid Res. 1968;9:110–9.PubMedGoogle Scholar
  24. 24.
    Björntorp P, Hood B, Martinsson A, Persson B. The composition of human subcutaneous adipose tissue in obesity. Acta Med Scand. 1966;180:117–21.CrossRefPubMedGoogle Scholar
  25. 25.
    Björntorp P, Sjöström L. Number and size of adipose tissue fat cells in relation to metabolism in human obesity. Metabolism. 1971;20:703–13.CrossRefPubMedGoogle Scholar
  26. 26.
    Fried S, Kral JG. Adipose tissue morphology, metabolism, and growth. In: Teimourian B, editor. Suction lipectomy and body sculpturing. St. Louis: Mosby; 1986. p. 15–32.Google Scholar
  27. 27.
    Hirsch J, Knittle J. Cellularity of obese and nonobese human adipose tissue. Fed Proc. 1970;29:1516–21.PubMedGoogle Scholar
  28. 28.
    Hirsch J. Adipose cellularity in relation to human obesity. Adv Intern Med. 1971;17:289–300.PubMedGoogle Scholar
  29. 29.
    Kral JG. Surgical reduction of adipose tissue hypercellularity in man. Scand J Plast Reconstr Surg. 1975;9:140–3.CrossRefPubMedGoogle Scholar
  30. 30.
    Fournier PF, Illouz Y-G. Collapsing surgery and body sculpturing. In: Regnault P, Daniel RK, editors. Aesthetic plastic surgery principles and techniques. Boston: Little Brown; 1984. p. 686–7.Google Scholar
  31. 31.
    Illouz Y-G, de Villers YT. Body sculpturing by lipoplasty, vol. 1989. Edinburgh: Churchill Livingstone. p. 27.Google Scholar
  32. 32.
    Sjöström L, Kvist H, Cederblad Å, Tylén U. Determination of total adipose tissue and body fat in women by computed tomography, 40K, and tritium. Am J Phys. 1986;250(Endocrinol. Metab. 13):E736–45.Google Scholar
  33. 33.
    St-Onge M-P, Wang J, Shen W, et al. Dual-energy x-ray absorptiometry-measured lean soft tissue mass: differing relation to body cell mass across the adult life span. J Gerontol A Biol Sci Med Sci. 2004;59A:796–800.CrossRefGoogle Scholar
  34. 34.
    Pietrobelli A, Wang Z, Formica C, Heymsfield SB. Dual-energy X-ray absorptiometry: fat estimation errors due to variation in soft tissue hydration. Am J Phys. 1998;274:E808–16.Google Scholar
  35. 35.
    Abate N, Burns D, Peshock RM, Garg A, Grundy SM. Estimation of adipose tissue mass by magnetic resonance imaging: validation against dissection in human cadavers. J Lipid Res. 1994;35:1490–6.PubMedGoogle Scholar
  36. 36.
    Ross R, Shaw KD, Martel Y, de Guise J, Avruch L. Adipose tissue distribution measured by magnetic resonance imaging in obese women. Am J Clin Nutr. 1993;57:470–5.CrossRefPubMedGoogle Scholar
  37. 37.
    Klein S, Fontana L, Young VL, et al. Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. N Engl J Med. 2004;350:2549–57.CrossRefPubMedGoogle Scholar
  38. 38.
    Chung KC, Kalliainen LK, Spilson SV, Walters MR, Kim HM. The prevalence of negative studies with inadequate statistical power: an analysis of the plastic surgery literature. Plast Reconst Surg. 2002;109:1–6. discussion 7–8CrossRefPubMedGoogle Scholar
  39. 39.
    Leibel RL, Rosenbaum M, Hirsch J. Changes in energy expenditure resulting from altered body weight. N Engl J Med. 1995;332:621–8.CrossRefPubMedGoogle Scholar
  40. 40.
    Swanson E. Assessment of reduction in subcutaneous fat thickness after liposuction using magnetic resonance imaging. Presented at Scientific Meeting of the American Society of Plastic Surgeons, Denver, CO 24 Sept 2011.Google Scholar
  41. 41.
    Swanson E. Prospective clinical study reveals significant reduction in triglyceride level and white cell count after liposuction and abdominoplasty and no change in cholesterol levels. Plast Reconstr Surg. 2011;128:182e–97e.CrossRefPubMedGoogle Scholar
  42. 42.
    Swanson E. A measurement system for evaluation of shape changes and proportions after cosmetic breast surgery. Plast Reconstr Surg. 2012;129:982–92. discussion 993CrossRefPubMedGoogle Scholar
  43. 43.
    Killinger DW, Perel E, Daniilescu D, Kharlip L, Lindsay WR. The relationship between aromatase activity and body fat distribution. Steroids. 1987;50:61–72.CrossRefPubMedGoogle Scholar
  44. 44.
    Anderson LA, McTernan PG, Barnett AH, Kumar S. The effects of androgens and estrogens on preadipocyte proliferation in human adipose tissue: influence of gender and site. J Clin Endocrinol Metab. 2001;86:5045–51.CrossRefPubMedGoogle Scholar
  45. 45.
    Simpson E, Rubin G, Clyne C, et al. The role of local estrogen biosynthesis in males and females. Trends Endocrinol Metab. 2000;11:184–8.CrossRefPubMedGoogle Scholar
  46. 46.
    Flynn TC. Breast enlargement observed after power liposuction: a retrospective review (commentary). Dermatol Surg. 2003;29:928.Google Scholar
  47. 47.
    Gurunluoglu R. Photographic measurements in 301 cases of liposuction and abdominoplasty reveal fat reduction without redistribution (Discussion). Plast Reconstr Surg. 2012;130:323e–4e.CrossRefPubMedGoogle Scholar
  48. 48.
    Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Therapy. In: Evidence-based medicine. 2nd ed. Toronto: Churchill Livingstone; 2000. p. 105–54.Google Scholar
  49. 49.
    LeBlanc M, Rebello C, Caruso-Davis M, Guillot T, Bissoon L, Greenway F. Thigh girth loss in women with lower body fat distribution increases breast volume. Plast Reconstr Surg. 2013;132:483e–4e.CrossRefPubMedGoogle Scholar
  50. 50.
    Swanson E. Prospective photographic measurement study of 196 cases of breast augmentation, mastopexy, augmentation/mastopexy, and breast reduction. Plast Reconstr Surg. 2013;131:802e–19e.CrossRefPubMedGoogle Scholar
  51. 51.
    Sarwer DB, Gibbons LM, Magee L, et al. A prospective, multisite investigation of patient satisfaction and psychosocial status following cosmetic surgery. Aesthet Surg J. 2005;25:263–9.CrossRefPubMedGoogle Scholar
  52. 52.
    Eder M, Klöppel M, Müller D, Papadopulos NA, Machens HG, Kovacs L. 3D analysis of breast morphology changes after inverted T-scar and vertical-scar reduction mammaplasty over 12 months. J Plast Reconstr Aesthet Surg. 2013;66:776–86.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Eric Swanson
    • 1
  1. 1.Swanson CenterLeawoodUSA

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