Assessment of the risk of systemic fat mobilization and fat embolism as a consequence of liposuction: ex vivo study.
BACKGROUND
Adverse consequences of liposuction, including those associated with fat embolism, have been reported in the literature. Fat embolism syndrome after liposuction may be underestimated because of the unspecific nature of the symptoms. The aim of this study was to determine whether there is a generic risk of the generation of intravascular fat emboli as a consequence of liposuction.


METHODS
An animal study was conducted in which liposuction was performed on 10 Sprague-Dawley rats. The procedure was conducted with the animals under general anesthesia for 60 minutes, in a similar manner to that practiced clinically. Three blood samples were taken from each animal through a central line (one before liposuction and two at 30 and 60 minutes into liposuction) and examined for the presence of fat particles. The animals were then euthanized and the lungs and brain were removed for histological examination. In the control group, liposuction was not performed, but similar blood and histological samples were taken.


RESULTS
In the study group, stained fat particles were seen in all blood samples taken during liposuction but not in those taken before liposuction. The difference between the 30- and 60-minute samples and the preliposuction control ones was statistically significant (p < 0.001 minimum). The differences between the 30-minute and 60-minute samples were also statistically significant (p = 0.017), demonstrating that fat mobilization during liposuction is a cumulative process. Nothing of significance was seen in the blood samples of the control group. Lipid deposits were seen in the lungs of all study group animals but not in the control group. With one possible exception, no lipid deposits were confirmed in brain specimens.


CONCLUSIONS
The authors' experiments have demonstrated a significant risk of systemic fat mobilization and fat embolism after liposuction in the animal model. Further clinical investigation is required to evaluate the real clinical risk of this procedure from this perspective.
El-Ali
Kamal M
KM
Department of Surgery, National Heart and Lung Institute, Imperial Collage School of Medicine, Hammersmith Hospital, London, United Kingdom.
Gourlay
Terence
T
D000818:Animals; D001921:Brain / Q000473:pathology; D004195:Disease Models, Animal; D004620:Embolism, Fat / Q000209:etiology* / Q000473:pathology*; D015187:Lipectomy / Q000009:adverse effects*; D008168:Lung / Q000473:pathology; D008297:Male; D011655:Pulmonary Embolism / Q000209:etiology / Q000473:pathology; D051381:Rats; D017207:Rats, Sprague-Dawley; D018570:Risk Assessment; D013997:Time Factors