A new study underscores the importance of exercise following a liposuction procedure and recovery in order to maintain a flat stomach.

According to Reuters, researchers from the University of Sao Paolo studied 36 women who had liposuction to remove a small amount of superficial abdominal fat. All of the study participants admitted to not exercising before the surgery, but half were advised to begin an exercise regime following the procedure.

Those who were told to exercise began doing so two months after their liposuction surgery and worked out three times per week.

After four months, researchers say that all of the study participants still had flatter bellies. However, those who didn't exercise had an increase in visceral fat, which is superficial abdominal fat under the skin. Those who did embark on an exercise program did not develop the fat deposits.

According to HealthBulletin.org, Visceral fat refers to fat surrounding the internal organs, specifically the liver. Harvard Medical School reports that unlike subcutaneous fat, which can be pinched, visceral fat exists deep within the abdominal cavity. It has been linked to metabolic disturbances and an increased risk for cardiovascular disease and type 2 diabetes. In women, it is also associated with breast cancer and the need for gallbladder surgery.

The Brazilian researchers, led by Fabiana Benatti, says that they're not sure why visceral fat may increase following liposuction surgery, but “if one should choose to undergo liposuction, it is very important [to] exercise after surgery.”

The study, published in The Journal of Clinical Endocrinology & Metabolism, is a small representation of patients, but experts say it reinforces the fact that liposuction is not a substitute for a lifestyle that includes a healthy diet and regular exercise.

The American Society for Aesthetic Plastic Surgery (ASAPS) reports that liposuction is a body contouring procedure that can target areas resistant to exercise and dieting. Most patients are encouraged to be a healthy weight before surgery and to maintain a healthy lifestyle following liposuction.