Effect of glucagon-like peptide-1 agonists on deep inferior epigastric perforator flap breast reconstruction outcomes in obese patients: A study of 5618 patients.

Abstract

Glucagon-like peptide-1 (GLP-1) agonists are frequently prescribed to manage obesity and diabetes. The effect of GLP-1 agonists on DIEP flap outcomes is unknown. This study compares outcomes in patients with class I/II obesity (BMI 30-40 kg/m²) with and without GLP-1 agonists and those with class III obesity to guide management. The TriNetX database (TriNetX LLC, Cambridge, MA) was analyzed (2005-2025) for patients who underwent DIEP based autologous breast reconstruction. Patients were divided into three groups: Group 1 (GLP-1 agonists with body mass index (BMI) of 30-40 kg/m²), Group 2 (no GLP-1 agonist with BMI of 30-40 kg/m²), and Group 3 (no GLP-1 agonist with BMI >40 kg/m²). Variables of interest included wound dehiscence, wound debridement, and revision surgery. Propensity score matching was performed. This retrospective cohort study included 5618 patients with 90-day follow-up. Group 1 had 212 patients, Group 2 had 4777 patients, and Group 3 had 629 patients. Group 3 had higher rates of wound debridement compared to Group 1 (class I/II obesity with GLP-1 agonist) (p=0.032) and Group 2 (class I/II obesity without GLP-1 agonist) (p=0.019). Group 1 had lower rates of revision surgery compared to Group 2 (p=0.037) and Group 3 (p=0.046). No differences were observed in wound dehiscence rates at 90 days. Patients with Class III obesity pursuing DIEP flap reconstruction should be counseled that weight loss with a GLP-1 agonist to a lower obesity class may decrease wound complications.