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Anatomy, physiology, and pathology of body fat

Subcutaneous body fat is a distinct anatomical entity with unique physiology, metabolism, and disease. The main roles of fat are energy storage, hormone production, and insulation. Free fatty acids and glycerol can be assembled into triglycerides, and conversely triglycerides can undergo lipolysis. Insulin is the key hormone that controls this fine balance. Pregnancy is associated with increased truncal body fat and breast ptosis. Cellulite is the padded appearance of fat and there is currently no single proven treatment. Lipomas are the most common soft tissue tumour and can be treated with excision or liposuction. Lipodystrophies are disorders characterized by the selective loss of body fat and lipofilling is a useful treatment modality. Panniculitis is the inflammation of subcutaneous fat and treatment involves dealing with the precipitating cause. The plastic surgeon should be familiar with the anatomy, physiology, and pathology of fat in order to treat this wide array of adipose-related conditions.