Breast reduction outcomes in massive weight loss: A comparative analysis of GLP-1 receptor agonist users, post-bariatric surgery patients, and controls.

[BACKGROUND] The increasing prevalence of GLP-1 receptor agonist use and bariatric surgery has created distinct patient populations seeking breast reduction for post-weight loss deformities. However, comparative outcomes data remain limited.

[METHODS] This retrospective cohort study followed the strengthening the reporting of observational studies in epidemiology recommendations for reporting observational studies. We analyzed 90 patients who underwent breast reduction surgery from 2020 to 2024, stratified into three matched groups: GLP-1 receptor agonist users (n = 30), post-bariatric surgery patients (n = 30), and controls (n = 30). Patients were matched based on age, body mass index, and comorbidity profile. Complications were classified as major complications (requiring reoperation) and overall complications (any intervention required).

[RESULTS] Major complication rates were low across all groups: controls 0/30 (0%), GLP-1 users 2/30 (6.7%), and post-bariatric patients 2/30 (6.7%, p = 0.368). Overall complications requiring any intervention differed significantly (p < 0.001): controls 3/30 (10.0%), GLP-1 users 7/30 (23.3%), and post-bariatric patients 19/30 (63.3%). Seroma formation varied markedly: controls 1/30 (3.3%), GLP-1 users 5/30 (16.7%), and post-bariatric patients 9/30 (30.0%, p=0.008). Skin necrosis occurred exclusively in post-bariatric patients (4/30, 13.3%, p = 0.041). Multivariable analysis identified hypoalbuminemia (OR 8.5, p = 0.005) and post-bariatric status (OR 15.6, p < 0.001) as independent risk factors. Preoperative albumin levels were significantly lower in post-bariatric patients (3.5 ± 0.2 g/dL) versus GLP-1 users (4.0±0.2 g/dL) and controls (4.2±0.2 g/dL, p < 0.001).

[CONCLUSIONS] Post-bariatric surgery patients demonstrated significantly higher complication rates compared to GLP-1 users and controls. Hypoalbuminemia and post-bariatric status emerged as independent risk factors for complications. These findings support enhanced preoperative optimization for massive weight loss populations.