INTRODUCTION

Glucagon-like peptide-1 (GLP-1) receptor agonists have become increasingly popular as a pharmacologic treatment for weight loss. While their metabolic benefits are well-documented, their effects on surgical outcomes are not well defined. Recent studies have suggested that GLP-1 agonists may impact wound healing, immune response, and fat metabolism, which are critical factors in reconstructive procedures. In implant-based breast reconstruction, these medications may alter the healing process and affect the overall aesthetic and functional results due to their role in fat reduction. This study aims to evaluate the effects of postoperative GLP-1 agonist use on complication and revision rates in patients undergoing two-stage expander-implant breast reconstruction. 

METHODS

This is a retrospective, single-institution study analyzing patients who underwent two-stage expander-implant breast reconstruction following oncologic resection from 2017 to 2022. Patients identified as using GLP-1 agonists postoperatively were included in the study. A control group of age-matched patients who did not use GLP-1 agonists was randomly selected from the same time period.

Patient demographics, operative details, and postoperative outcomes were collected, including rates of complications and revision surgeries. Recorded complications included capsular contracture, infection, hematoma, implant malposition, and other relevant adverse events. Revision procedures performed up to the present date were documented. Statistical analysis was conducted to compare outcomes between the two groups.

RESULTS

A total of 92 patients were included in this study, with 45 (49%) having used GLP-1 agonists at least once weekly for any duration following tissue expander placement. The cohort had a mean age of 52.1 years and a mean body mass index (BMI) of 26.1 kg/m². Among these patients, 27 underwent unilateral reconstruction, while 65 underwent bilateral reconstruction.

The overall cohort had an average of 0.9 revision surgeries per patient. A total of 11 complications (12%) were recorded, including six cases of capsular contracture, three infections, one case of implant migration, and one hematoma.

Patients who used GLP-1 agonists postoperatively had a significantly higher revision rate compared to those who did not (1.27 vs. 0.64, p=0.027). Additionally, postoperative GLP-1 agonist users experienced significantly more complications (22% vs. 2%, p<0.01), suggesting a potential negative impact on surgical healing and long-term outcomes.

However, these results may have been confounded by BMI, as patients who took GLP-1 agonists postoperatively were noted to have significantly higher BMI compared to the control group (28.7 vs. 23.7, p<0.01), and as a result significantly higher rates of medical comorbidities. 

CONCLUSION

Our preliminary data indicate that the postoperative use of GLP-1 agonists is associated with a significantly increased risk of complications and revision surgeries in patients undergoing two-stage expander-implant breast reconstruction. These findings underscore the importance of thorough preoperative counseling for patients using GLP-1 agonists. Further studies with larger cohorts and prospective designs are warranted to better understand the mechanisms underlying these associations and to guide clinical decision-making in breast reconstruction surgery.