Following Lipectomy to Understand Adipose Tissue Re-accumulation
Condition: Menopause; Pre-menopause
Study type: Interventional

Summary: 
      The typical female pattern of accumulating fat in the hips and thighs has long been thought
      to confer less risk for disease than the typical male abdominal fat pattern. However, leg fat
      may not simply be benign with respect to disease risk, but may in fact protect against
      cardiovascular disease risk. Although the mechanism for this is unknown, the investigators
      hypothesize that removing a portion of this important fat depot (via liposuction) could
      increase disease risk. Such unfavorable results may or may not be transient depending on an
      individual's ability to defend their fat mass. Because sex hormones appear to play a role in
      regional fat accumulation, the investigators hypothesize that estrogen-deficient
      postmenopausal women may have an augmented abdominal fat accumulation and an attenuated hip
      and thigh re-accumulation compared to premenopausal women following lipectomy and compared to
      non-surgical controls. As a result, the increased abdominal fat accumulation may worsen
      disease risk in postmenopausal women. Menopause-related differences in fat storage at
      baseline are also expected to determine the degree to which lipectomy alters disease risk and
      the propensity for AT re-accumulation.
    

Detailed description: 
      Lipectomy is the most frequently performed aesthetic surgery in the U.S. today and is
      considered permanent, by The American Society for Aesthetic Plastic Surgery, but no long term
      follow-up studies have been done to verify this assertion. Indeed, animal studies suggest
      rapid adipose tissue (AT) re-accumulation after lipectomy is common and may even be
      accompanied by unfavorable changes in disease risk. Recent studies in humans have focused on
      abdominal lipectomy as a means of reducing metabolic disease risk in obese premenopausal
      women. However, none of these studies evaluated AT re-accumulation or reported long-term (>6
      mo) changes in metabolic outcomes, and none have evaluated the effect of removing femoral AT
      despite this being a common site for lipectomy in women and despite the apparent
      cardioprotective benefit of lower body adiposity. Further, none of these studies included
      postmenopausal women who are at an increased risk of abdominal AT accumulation. It is the
      investigator's overall working hypothesis that removal of femoral AT by lipectomy may worsen
      metabolic disease risk (as measured by postprandial lipemia) in estrogen-deficient
      postmenopausal women who, in contrast to premenopausal women, will accumulate AT in the
      abdominal rather than the femoral region. The global aims of this study are to determine
      whether: 1) there are menopause-related differences in regional (abdominal vs. femoral) AT
      re-accumulation following lipectomy; and 2) changes (removal and regain) in femoral AT mass
      alter postprandial triglyceride clearance and storage of meal-derived fatty acids. Further,
      the investigators postulate that menopause-related differences in postprandial lipemia and
      handling of dietary fatty acids will determine the degree to which femoral lipectomy worsens
      these parameters. Pre- and postmenopausal women (n=80) will be randomly assigned to either
      femoral lipectomy or control (no surgery). All eligible volunteers will undergo testing at
      the beginning of the study and at 2, 8, and 14 months following lipectomy. Measurements will
      include body composition assessments, meal tests and AT biopsies to assess lipectomy-related
      changes in: 1) abdominal and femoral fat mass; 2) systemic postprandial triglyceride
      excursions; and 3) storage of dietary fatty acids in AT. These studies are designed to
      evaluate the effect of femoral lipectomy on regional AT re-accumulation and metabolic disease
      risk in pre- and postmenopausal women.
    

Intervention name(s): Femoral lipectomy
Intervention type(s): Procedure
Intervention description(s): Standard (non-experimental) suction assisted liposuction surgery
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: liposuction; adipose tissue; dietary fatty acids; triglyceride storage; Normal healthy aging