Abdominoplasty Outcomes after GLP-1 Agonist-Induced versus Post-Bariatric Massive Weight Loss: A Retrospective Comparative Case Series

Background: Glucagon-like peptide-1 (GLP-1) receptor agonists have revolutionized pharmacologic weight reduction, creating a rapidly growing cohort of massive weight loss patients seeking body contouring. Unlike post-bariatric patients, this population lacks prior surgical scars and may have different nutritional and healing profiles. Methods: A retrospective comparative case series was conducted from January 2022 to November 2024. Twenty patients who achieved massive weight loss (≥20 kg) through GLP-1 therapy were matched 1:1 with post-bariatric controls by sex, age (±5 years), and postoperative body mass index (±3 kg/m²). Patients underwent abdominoplasty. Primary outcome was any complication within 90 days. Multivariable analysis assessed the independent effect of treatment modality. Results: Groups were matched for age (GLP-1: 44.1±7.8 vs bariatric: 42.8±7.0 years, p=0.554) and postoperative BMI (29.0±2.4 vs 30.6±4.2 kg/m², p=0.163). Weight loss magnitude was lower in GLP-1 patients (29.9±5.7 vs 47.2±6.0 kg, p<0.001). Superior nutritional status was observed in GLP-1 patients, with higher albumin (4.0±0.3 vs 3.6±0.4 g/dL, p=0.021) and prealbumin levels (23.2±4.1 vs 18.9±2.8 mg/dL, p=0.003). Overall complication rate showed a trend toward lower rates in the GLP-1 cohort (20% vs 40%, odds ratio 0.38, 95% CI 0.09-1.54, p=0.301). In comprehensive multivariable analysis controlling for weight loss magnitude, duration, albumin, and pannus weight, the direction of effect favoring GLP-1 patients remained consistent (adjusted OR 0.72, 95% CI 0.03-15.0, p=0.830). Conclusions: Abdominoplasty following GLP-1-induced massive weight loss demonstrates trends toward favorable safety profiles and patient satisfaction compared to post-bariatric patients, with effects that persist after comprehensive adjustment for potential confounders.