Surgical Fat: The Tummy Tuck

In my world, plastic surgeons make people beautiful again with sometimes intense and lengthy surgical procedures. I’ve had the occasion to sit in on a number of these procedures with plastic surgery colleagues and wanted to lend a little insight (and a break from the tedium of trans fat) into the process.

One of my least favorite procedures to observe is the abdominoplasty. The abdominoplasty or “tummy tuck” as it’s commonly called is a procedure which removes a significant portion of abdominal subcutaneous fat. Tummy seems innocent enought and tuck doesn't nearly describe the size of the incision. In fact, the fat is usually excised (cut out) in large blocks, by making rather large incisions across the lower abdomen. Being the curious one, I poked and prodded at the newly excised big block of yellow fat.

The yellow color of human fat actually depends on the dietary intake of carotenoids from carrots, yellow peppers and other colorful vegetables; a diet low in those vegetables gives the fat a paler, pastier color. The technical term for yellow fat is actually “White Fat” or simply "adipose tissue" which is held in distinction to “Brown Fat” a form of fat much more metabolically active. Brown fat actually gets its brown color from a clustering of mitochondria within each cell, allowing for intense metabolic activity. Bears and hibernating mammals use brown fat to slowly metabolize fat stores and survive the winters. Adult humans use very little if any brown fat.

With gloved hands I lifted the block of fat to test the weight of said extra tissue. It was weighty, but more than that, it was awkward not attached to the middle of the patient’s body—it slipped and flopped around like a shifty slab of fish. I set the block down and ran the corner of pure fat between my fingers. To foreigners outside the daily environment of the operating room, this process might sound a bit nauseating; but to those working in an operating room on a daily basis, the site of a tissue mass such as this is nothing short of benign. The fat seemed to come off in globules connected by a cellophane thin membrane breaking the fat up into discrete packets of thumb-sized tissue. Pressing the tissue between my finger and thumb instantly gave my gloves a greasy covering as the actual fat (triglyceride) held tight within the cells was partially ruptured, spilling out over my gloves.

Upon closer inspection, a spider web of tiny blood vessels laced itself through the tissue to offer a connection between the adipose (fat) cells containing the triglyceride (storage form of fat) and the systemic circulation—it was a liquid conduit of connectivity not in any way different than the plumbing system of a typical house or apartment. A mesh of fine nerve fibers was networked between the cells and complemented the wiring system of the house. Like any living tissue with function and purpose, fat cells need connectivity with blood and nerve fibers to integrate that specialized tissue to the greater functioning of the organism. With the naked eye, that’s about the extent of what an inspection of a block of human fat might reveal. Beyond that, a high-powered microscope is needed to reveal the minute world the fat cell resides within.
More on their microscopic world later.