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Comparative Analysis Of Postoperative Outcomes In Breast Reduction Patients On Glp-1 Receptor Agonists: A Nationwide Analysis Using Epic Cosmos
Chris Amro, MD, Rebecca Lisk, BS, Carter J. Boyd, MD, Thomas J. Sorenson, MD, Jenn Park, MD, Lauren E. Romanowski, MD, Oriana Cohen, MD, Mihye Choi, MD, Nolan S. Karp, MD.
NYU Langone, New York, NY, USA.
PURPOSE: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for obesity and type 2 diabetes, with expanding off-label use for weight loss. Their perioperative safety profile in breast reduction surgery remains poorly characterized.
METHODS: A retrospective cohort study within Epic Cosmos including adults undergoing breast reduction in the United States from 2014-2025 was performed. GLP-1 RA use was defined as therapy for at least 6 months preceding surgery. Demographics and 90-day postoperative complications were compared.
RESULTS: A total of 224,822 patients undergoing breast reduction were identified, of whom 7,452 used GLP-1 RAs for more than 6 months preoperatively. Compared with non-users, patients taking GLP-1 were older (50 vs 42, p<0.05) and had higher BMI (36.8 vs 32.3, p<0.05). Median duration of therapy was 395 days (IQR 267-641). Complication rates were significantly higher with GLP-1 use including hematoma (1.9% vs 1.3%; p<0.05), seroma (1.7% vs 0.9%;p<0.05), wound dehiscence (3.9% vs 2.6%;p<0.05), DVT (0.76% vs. 0.55%;p<0.05) and surgical site infection (1.5% vs 0.7%;p<0.05). In adjusted analyses, GLP-1 use was independently associated with seroma formation (OR=1.95, 95% CI 1.63-2.34, p<0.05), hematoma (OR=1.43, 95% CI 1.21-1.70, p<0.05), wound dehiscence (OR=1.55,95%CI 1.38-1.75, p<0.05), and soft tissue infection (OR=2.04,95%CI 1.68-2.48).
CONCLUSION: This national analysis provides the first large-scale evaluation of GLP-1 RA use in breast reduction surgery. GLP-1 is independently associated with increased risk of wound complications, highlighting the need for careful risk stratification and perioperative management in this population.
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