Sir: We read with interest the article by Fuller et al. regarding the long-term weight reduction following abdominoplasty.1 The authors report that all patients (n = 20) had weight loss beyond that of their resected pannus, with the minimum body mass index to be achieved 3 months postoperatively. Interestingly, 70 percent had sustained this weight loss at the 1-year follow-up. The authors claim that preoperative body mass index greater than 24.5kg/m2 or pannus resection greater than 4.5 lb (2kg) appears to be linked to sustained weight loss at 1 year. They attribute these results to an increase in satiety, described by 75 percent of patients. To answer the research question set by the authors (i.e., long-term weight reduction after abdominoplasty), we conducted a systematic review applying the Meta-analysis Of Observational Studies in Epidemiology criteria.2 PubMed, EMBASE, and Cochrane Library databases were searched until February of 2013. The string search [“lipectomy” or “liposuction” or “abdominoplasty”] and [“obesity” or “overweight” or “weight loss”] was applied, and limited to “human.” This search was supplemented by a review of reference lists of potentially eligible studies. Inclusion criteria were (1) prospective design, (2) female patients only,3 and (3) minimum follow-up of 3 months. In controlled trials, only the lipectomy arm was included. Exclusion criteria were (1) liposuction not involving the abdomen, (2) concomitant use of weight management strategies (i.e., diet, exercise, and medication), (3) comorbidity (e.g., diabetes), and (4) duplication of data among studies. The main outcome was body mass index change. Data were extracted independently by two reviewers (Fig. 1). Eleven studies were included in the systematic review and separated into three groups based on the length of follow-up: short (3 to 4 months), medium (6 to 11 months), and long (≥12 months) (Table 1). Abdominal liposuction, mostly large-volume, was performed in nine studies, whereas abdominoplasty was performed in three studies. The short follow-up group included three studies of 145 patients.4–6 Significant body mass index change was reported in each study, which corresponded to the lipectomy mass. Similar results were recorded in the medium follow-up group of 242 patients, in all but one study with normal-weight subjects.7–11 Finally, the long follow-up group included three studies with 34 patients.12–14 The results were inconclusive, as one study reported significant weight loss, one reported no change, and one reported weight gain (Table 1).Table 1: Systematic ReviewIn conclusion, this systematic review confirms the body mass index reduction that follows abdominal lipectomy in overweight and obese female patients; nevertheless, this reduction corresponds to the lipectomy mass with no additional benefit. In addition, this “lipectomy effect” seems to subside after 1 year. The retrospective design of the study by Fuller et al. study prohibited its inclusion in the systematic review. Some of its inherited characteristics (i.e., observer, recording, and selection bias) may have led to an exaggeration of the benefits that accompany lipectomy. Large, prospective studies, with an adequate follow-up period, focusing on the effect of abdominal lipectomy on the inflammatory markers and hormones of the adipose tissue, may further elucidate the role of this therapeutic approach. Disclosure The authors have no financial interest to declare in relation to the content of this communication. Efterpi Demiri, M.D., Ph.D. Department of Plastic Surgery Medical School Aristotle University of Thessaloniki Thessaloniki, Greece Georgios Koliakos, M.D., Ph.D. Laboratory of Biochemistry Dimitrios G. Goulis, M.D., Ph.D. Unit of Reproductive Endocrinology Konstantinos Seretis, M.D., M.Sc. Department of Plastic Surgery