Abdominoplasty Outcomes after GLP-1 Agonist-Induced versus Postbariatric Massive Weight Loss: A Retrospective...

Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) have revolutionized pharmacologic weight reduction, creating a rapidly growing cohort of patients with massive weight loss seeking body contouring. Unlike postbariatric patients, this population lacks previous surgical scars and may have different nutritional and healing profiles.

A retrospective comparative case series was conducted from January of 2022 through November of 2024. Twenty patients who achieved massive weight loss (≥20 kg) through GLP-1 RA therapy were matched 1:1 with postbariatric controls by sex, age (±5 years), and postoperative body mass index (±3 kg/m 2 ). The patients underwent abdominoplasty. The primary outcome was any complication within 90 days. Multivariable analysis was used to assess the independent effect of treatment modality.

Groups were matched for age (44.1 ± 7.8 [GLP-1 RA] versus 42.8 ± 7.0 [bariatric] years [ P = 0.554]) and postoperative body mass index (29.0 ± 2.4 [GLP-1 RA] versus 30.6 ± 4.2 [bariatric] kg/m 2 [ P = 0.163]). Weight loss magnitude was lower in patients taking GLP-1 RAs (29.9 ± 5.7 versus 47.2 ± 6.0 kg [ P < 0.001]). Superior nutritional status was observed in patients taking GLP-1 RAs, with higher albumin (4.0 ± 0.3 versus 3.6 ± 0.4 g/dL [ P = 0.021]) and prealbumin levels (23.2 ± 4.1 versus 18.9 ± 2.8 mg/dL [ P = 0.003]). The overall complication rate showed a trend toward lower rates in the GLP-1 RA cohort (20% versus 40%; OR, 0.38 [95% CI, 0.09 to 1.54] [ P = 0.301]). In comprehensive multivariable analysis controlling for weight loss magnitude, duration, albumin, and pannus weight, the direction of effect favoring patients taking GLP-1 RAs remained consistent (adjusted OR, 0.72 [95% CI, 0.03 to 15.0] [ P = 0.830]).

Abdominoplasty following GLP-1 RA-induced massive weight loss demonstrates trends toward favorable safety profiles and patient satisfaction compared with postbariatric surgery, with effects that persist after comprehensive adjustment for potential confounders.