Weight Loss Medications May Affect Some Complications After Panniculectomy
For GLP-1 users, some risks are higher but others lower, reports Plastic and Reconstructive Surgery

For patients undergoing body contouring surgery to remove excess abdominal skin after massive weight loss, use of GLP-1 weight loss medications may have mixed effects on complication risks, suggests a study in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer.

"As GLP-1 receptor agonist [GLP1ra] medications become increasingly integrated into the care of patients undergoing body contouring, our findings suggest that these drugs may have subtle effects on wound healing, even if they don't increase overall surgical risks," comments lead author Zachary Andrew Koenig, MD, of West Virginia University School of Medicine, Morgantown.

Do GLP-1 medications affect body contouring risks?

Body contouring describes a range of surgical procedures to remove excess skin and soft tissue in patients with major weight loss. Panniculectomy is a procedure to address loose, hanging skin and fat (pannus) from the lower abdomen.

Plastic surgeons are seeing a surge in the number of patients taking GLP-1 medications for weight loss and/or treatment of type 2 diabetes. Plastic surgeons may prescribe GLP-1 drugs themselves – for example, to help optimize a patient's body weight before body contouring surgery.

Previous studies have suggested possible effects of GLP-1 medications on wound healing. These concerns are especially relevant for patients undergoing panniculectomy, many of whom are already taking or are candidates for GLP-1 treatment.

Dr. Koenig and colleagues analyzed the outcomes of 373 patients undergoing panniculectomy at their medical center from 2013 to 2023. Of these, 21.7% of patients were taking GLP-1 medications before surgery – a rate that increased sharply in recent years. To isolate the effects of GLP-1 drugs, the study excluded patients undergoing bariatric or hernia surgery.

Differences in characteristics and complications for GLP-1 users

On analysis of patient characteristics, those taking GLP-1 medications were more likely to have type 2 diabetes, high blood pressure, and chronic obstructive pulmonary disease. However, body mass index was not significantly different between groups.

Patients using GLP-1 medications were at a higher risk of delayed wound healing: 18.5%, compared to 7.5% in the non-GLP-1 group. In contrast, GLP-1 users had a lower rate of seroma, or fluid build-up under the wound: 4.9% versus 14.0%. Both differences remained significant after adjustment for other factors. Other complications – including reopening of the surgical wound (dehiscence), infection, and rehospitalization rate – were similar between groups.

The study suggests a "complex and nuanced interplay" between GLP-1 treatment and healing after panniculectomy. The findings "reinforce that while GLP1ra appear broadly safe perioperatively, their impact on soft tissue healing...may involve unique mechanisms not yet fully understood," Dr. Koenig and colleagues write. They note that their study represents a unique patient population, as West Virginia has the highest rate of GLP-1 prescriptions nationwide.

"Our findings suggest that while GLP1ra therapy does not appear to increase major surgical risk, it may affect specific aspects of healing that warrant proactive management," Dr. Koenig and coauthors conclude. Within its limitations, the study "provides valuable data on a rapidly evolving clinical landscape." The researchers emphasize the need for ongoing research, including formal guidelines related to GLP-1 medications and plastic surgery.

Plastic and Reconstructive Surgery® is published by Wolters Kluwer.

Click here to read "Perioperative GLP-1 Receptor Agonist Use and Surgical Outcomes in Nonbariatric Abdominal Panniculectomy: A 10-Year Retrospective Analysis"

Article: "Perioperative GLP-1 Receptor Agonist Use and Surgical Outcomes in Nonbariatric Abdominal Panniculectomy: A 10-Year Retrospective Analysis" (doi: 10.1097/PRS.0000000000012405)