GLP-1s may affect some complications after panniculectomy

For patients undergoing body contouring surgery to remove excess abdominal skin after significant weight loss, use of GLP-1 weight-loss medications may have mixed effects on complication risks, according to a study by researchers from West Virginia University School of Medicine, Morgantown, WV.

Share of all patients who take a GLP-1 RA by state. Credit: Plastic & Reconstructive Surgery (2025). DOI: 10.1097/prs.0000000000012405

"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," explained lead author, Dr Zachary Andrew Koenig from West Virginia University School of Medicine.

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 optimise 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.

Koenig and colleagues analysed the outcomes of 373 patients undergoing panniculectomy at their medical centre 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.

On analysis of patient characteristics, those taking GLP-1 medications were more likely to have type 2 diabetes (55.6% versus 29.5% [p=0.01]), hypertension (69.1% versus 52.7% [p=0.04]), and chronic obstructive pulmonary disease (17.3% versus 6.5% [p=0.02]), along with elevated prealbumin levels (22.8 ± 6.6 versus 20.4 ± 7.7 mg/dL [p=0.030]). However, body mass index was not significantly different between groups.

Patients using GLP-1 medications were at higher risk of delayed wound healing: 18.5%, compared to 7.5% in the non-GLP-1 group (p=0.0066). In contrast, GLP-1 users had a lower rate of seroma, 4.9% versus 14.0% (p=0.032). Both differences remained significant after adjustment for other factors. Other complications - including reopening of the surgical wound (dehiscence), infection, and rehospitalisation rate - were similar between groups.

“As GLP-1 RAs become increasingly integrated into the care of patients undergoing body contouring, their perioperative effects demand closer scrutiny. Our findings highlight that these agents may subtly alter wound-healing dynamics - delaying closure while reducing seroma formation - without increasing overall surgical risk,” Koenig and co-authors concluded. “Rather than contraindicating surgery, GLP-1 RA use represents a pharmacologic modifier of tissue behaviour that plastic surgeons must account for in both preoperative planning and postoperative management. These results underscore the need for formal guidelines and further research at the intersection of metabolic therapy and aesthetic surgery.”

The findings were reported in the paper, Perioperative GLP-1 Receptor Agonist Use and Surgical Outcomes in Nonbariatric Abdominal Panniculectomy: A 10-Year Retrospective Analysis, published in the journal Plastic & Reconstructive Surgery.  To access this paper, please click here