Effects of GLP-1 Receptor Agonists on Breast Reconstruction Outcomes: A Large-Database Retrospective Study

Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for diabetes and weight loss, with many breast reconstruction candidates being prescribed these medications. However, perioperative risks remain unclear. This study evaluated the association between GLP-1RA use and postoperative complications in implant-based and autologous tissue breast reconstruction. Methods: A retrospective analysis of TriNetX identified patients undergoing implant-based or autologous tissue breast reconstruction. Preoperative GLP-1RA users were compared to matched controls. Patients were propensity score matched (1:1 and 1:3) for demographics and comorbidities including body-mass index and timing of reconstruction (delayed vs. immediate). Ninety-day outcomes were assessed using logistic regression. Results: Between 2014 and 2024, 57,987 patients were identified, of which 823 were GLP-1RA users. Of those users, 326 patients undergoing implant-based reconstruction and 51 patients undergoing autologous reconstruction were matched to controls. In implant-based cohorts, GLP-1RA use was associated with increased odds of implant failure (1:1 OR 1.70, 95% CI 1.18-2.45, p = 0.0046), wound healing complications (1:1 OR 1.90, p = 0.027), and higher readmission/ED utilization (1:1 OR 1.80, 95% CI 1.04-3.21, p = 0.040). No significant differences were observed for hematoma, seroma, or thromboembolism. In autologous reconstruction, GLP-1RA use was not associated with increased risks. Conclusions: GLP-1RA use is linked to higher rates of implant failure, wound healing complications, and readmission in implant-based breast reconstruction only. These findings highlight the need for risk stratification and counseling of GLP-1RA users undergoing implant-based procedures and for further research investigating the implications of perioperative use of these agents in plastic surgery.