Liposuction is a technique which permits ‘blind’ removal of subcutaneous fat through a small skin incision. Its most frequent clinical role is a cosmetic one, in the removal of unwanted subcutaneous fat as an element in ‘body sculp-turing’, but it also has a small place in routine plastic surgical practice, in removing large lipomas and defatting unduly bulky skin flaps to make them conform to the surrounding contour after completion of their transfer.
It allows a large area to be defatted through a small skin incision, reducing scarring and simplifying postoperative care. Depending on whether the procedure is being carried out under local or general anaesthesia, the fat to be aspir-ated is infiltrated with a local anaesthetic agent or saline, containing adrenaline in low concen-tration. This facilitates aspiration and helps in achieving haemostasis.
A small skin incision is made, and the suction cannula is inserted into the subcutaneous layer in the area to be aspirated and attached to a high-pressure suction pump. It is then moved to and fro like a piston, directed radially from the site of insertion through an arc. The cannula is blunt ended, and in its to and fro movements it disrupts the fat, which is sucked out into the suction pump reservoir, the blood vessels traversing the area largely escaping damage.
It is important that the suction should not be applied, either superficially as far as the deep surface of the dermis which results in a lumpy skin surface, or deeply as far as the deep fascia! layer which creates an area of adhesion of the skin. With suction completed, a pressure dressing is applied to the site. Local bruising can be considerable, but infective complications are infrequent.
Lipomas with little or no fibrous tissue are readily treated by this technique, but those with a more extensive fibrous stroma are difficult to remove, and may require formal excision. The flaps which benefit from debulking tend to be from the groin or hypogastrium, and although it is suggested that fat does not reaccumulate after removal, flaps from those sites are notorious for redeveloping subcutaneous fat if the patient puts on weight. When this occurs, the procedure may have to be repeated.