Panniculectomy With Umbilical Transposition in the Era of GLP-1 Receptor Agonists: The Impact of Weight Loss Modality on Post-Operative Outcomes

Background Panniculectomy is performed to address excess infraumbilical skin and soft tissue following weight loss. Weight loss can be achieved through lifestyle modifications, bariatric surgery, and pharmacologic therapies, such as glucagon-like peptide-1 (GLP-1) agonists. The impact of weight loss modality on post-operative outcomes remains unclear. Objectives To evaluate whether the method of weight loss influences post-operative outcomes following panniculectomy. Methods A single-center retrospective review was conducted of patients who underwent panniculectomy between 2021 and 2025. Patients were grouped into four cohorts: lifestyle modifications alone, bariatric surgery, GLP-1 agonist therapy, or combined bariatric surgery and GLP-1 agonist therapy. Patients receiving abdominoplasty with extensive undermining and rectus plication were excluded. Variables of interest included patient demographics, weight loss history, comorbidities, wound healing complications, surgical site infection, hematoma/seroma, and hospital utilization. Multivariate logistic regression was performed to analyze post-operative complications and healthcare utilization, with statistical significance set at p < 0.05. Results A total of 281 patients met inclusion criteria (lifestyle modifications: n=53 (18.9%); bariatric surgery: n=184 (65.5%); GLP-1 agonist therapy: n=20 (7.1%); and combined bariatric surgery and GLP-1 agonist therapy: n=24 (8.5%)). Multivariate analysis showed no statistically significant differences in post-operative outcomes, including wound complications, surgical site infections, seroma/hematoma, or hospital utilization. Conclusions Post-operative outcomes following panniculectomy may be similar regardless of weight loss method. Pre-operative GLP-1 agonist therapy, alone or combined with bariatric surgery, was not associated with increased post-operative complications or healthcare utilization. Our results can help guide risk stratification and decision-making for individuals pursuing panniculectomy after weight loss.