GLP-1 Receptor Agonist Use and Wound Outcomes After Free Flap Breast Reconstruction

Area of Science:

• Plastic Surgery
• Endocrinology
• Pharmacology

Background:

• Glucagon-like peptide-1 receptor agonists (GLP-1s) are widely used for diabetes and weight management.
• The effect of GLP-1s on surgical wound healing, particularly in complex procedures like free flap breast reconstruction, is not well-established.
• Existing literature presents conflicting evidence regarding GLP-1s' impact on surgical complications.

Purpose of the Study:

• To investigate the association between preoperative GLP-1 use and the incidence of postoperative wound complications.
• To evaluate the safety of GLP-1s in patients undergoing free flap breast reconstruction.
• To explore potential differences in outcomes based on diabetes status.

Main Methods:

• A retrospective cohort study utilizing the TriNetX Research Network.
• Adult patients undergoing free flap breast reconstruction between 2012 and 2025 were identified.
• Patients were propensity score-matched (1:1) based on GLP-1 use within one year prior to surgery.

Main Results:

• GLP-1 users exhibited significantly lower composite wound complication rates (9.0% vs. 17.1%, p=0.002) compared to non-users.
• Reduced rates of surgical site infections (4.1% vs. 8.1%, p=0.026) and wound dehiscence (3.8% vs. 7.8%, p=0.023) were observed in GLP-1 users.
• In non-diabetic patients, GLP-1 use was linked to significantly fewer complications (7.9% vs. 18.6%, p=0.007); outcomes were comparable in diabetic patients.

Conclusions:

• Preoperative GLP-1 use is not associated with an increased risk of wound complications in free flap breast reconstruction.
• GLP-1s may offer a protective effect on wound healing in this surgical context, particularly in non-diabetic individuals.
• The findings support the perioperative safety of GLP-1 receptor agonists.