Liposuction Preserves the Morphological Integrity of the Microvascular Network: Flow Cytometry and Confocal Microscopy Evidence in a Controlled Study

Liposuction is a very popular technique in plastic surgery that allows for the taking adipose tissue (AT) on large surfaces with little risk of morbidity. Although liposuction was previously shown to preserve large perforator vessels, little is known about the effects of liposuction on the microvasculature network. The aim of this study was to analyze the effect of liposuction on the preservation of microvessels at tissue and cellular levels by flow cytometry and confocal microscopy following abdominoplasty procedure. Percentage of endothelial cells in AT from liposuction and en bloc AT was determined by multicolor flow cytometry. Moreover, vessel density and adipocyte content were analyzed in situ in 3 different types of AT (en bloc, from liposuction, and residual AT after liposuction) by confocal microscopy. Flow cytometric analysis showed that en bloc AT contained 30.6% +/- 12.9% and AT from liposuction 21.6% +/- 9.9% of endothelial cells (CD31(pos)/CD45(neg)/CD235a(neg)/CD11b(neg)) (P = .009). Moreover, analysis of paired AT from the same patients (n = 5) confirmed a lower percentage of endothelial cells in AT from liposuction compared to en bloc AT (17.7% +/- 4.5% vs 21.9% +/- 3.3%, P = .031). Likewise, confocal microscopy showed that en bloc AT contained 8.2% +/- 6.3%, AT from liposuction only 1.6% +/- 1.0% (P < .0001), and AT after liposuction 8.9% +/- 4.1% (P = .111) of CD31(pos) vessels. Conversely, adipocyte content was 39.5% +/- 14.5% in the en bloc AT, 45% +/- 18.4% in AT from liposuction (P = .390), and 18.8 +/- 14.8% in AT after liposuction (P = .011). For the first time, we demonstrate that liposuction preserves the microvascular network. Indeed, a low percentage of endothelial cells was found in AT from liposuction and we confirm the persistence of microvessels in the tissue after liposuction.