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| Autors principals: | , , , , , , , |
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| Format: | Recurso digital |
| Idioma: | |
| Publicat: |
Zenodo
2026
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| Matèries: | |
| Accés en línia: | https://doi.org/10.5281/zenodo.20086238 |
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- PURPOSE: Patients with class III obesity (BMI >40 kg/m2) who undergo mastectomy are seldom offered deep inferior epigastric artery perforator (DIEP) free flap breast reconstruction at most centers. Glucagon-like peptide-1 (GLP-1) agonists are frequently prescribed to manage obesity and diabetes. The effect of GLP-1 agonists on postoperative outcomes in those who undergo DIEP flap breast reconstruction is not known. The purpose of this study is to compare outcomes after DIEP flap 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. METHODS: The TriNetX database (TriNetX LLC, Cambridge, MA) was analyzed (2005-2025) for patients who underwent DIEP based autologous breast reconstruction (CPT 19364; HCPCS S2066, S2067, S2068). Patients were divided into three groups. Group 1 used a GLP-1 agonist and had a body mass index (BMI) of 30-40 kg/m2. Group 2 did not use a GLP-1 agonist and had a BMI of 30-40 kg/m2. Group 3 did use a GLP-1 agonist and had a BMI >40 kg/m2. Propensity matching was conducted. Variables of interest included wound dehiscence, wound debridement, and revision surgery. P-values ≤0.05 were considered statistically significant. RESULTS: The study included 5618 patients with follow-up 90 days postoperatively. 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. CONCLUSION: Patients with a BMI >40 kg/m2 undergoing DIEP flap had significantly increased risk for wound complications compared to BMI 30-40 kg/m2 and an even higher risk compared to BMI 30-40 kg/m2 on GLP-1 agonists. Patients with a BMI >40 kg/m2 who seek DIEP flap reconstruction should be counseled that weight loss with a GLP-1 agonist to a lower obesity class may decrease wound complications.© 2026. Plastic Surgery Research Council | All rights reserved |*Source: https://ps-rc.org/meeting/Program/2026/CS03.cgi*