85. Plastic Surgery in the Ozempidemic: Considerations for the Timing of Body Contouring Surgery in Patients With Semaglutide-Associated Weight Loss

PURPOSE: GLP-1 agonists cause weight loss (WL) unprecedented among pharmacotherapy. Rising consumer interest has shifted the treatment landscape for obesity. Following massive WL, many patients show interest in breast and body contouring surgery (BCS) to address excess skin. BCS is appropriate once WL is stable, as post-operative weight change can distort outcomes. Weight is understood to stabilize 12-to-18 months after bariatric surgery, but the timeline for semaglutide-associated WL (SaWL) is not as defined and is moreover obscured by weight recurrence after drug discontinuation. Understanding this timeline is crucial for plastic surgeons to optimize BCS outcomes. METHODS: A systematic search of MEDLINE, Web of Science, and Cochrane was performed, resulting in 555 study results. RCTs and observational studies measuring weight change over time secondary to GLP-1 agonists were included. Time from drug initiation to weight loss plateau (WLP), defined as ≥ 1 month with WL <3%, was calculated for each study, and meta-analysis of pooled outcomes was performed. Time to weight recurrence (WR), defined as ≥25% of WL regained, was calculated for studies that included drug discontinuation. RESULTS: 41 articles met inclusion criteria. Of those, 10 investigated once-weekly subcutaneous semaglutide (n=4113 patients). WLP occurred at 53.0 (±8.2) weeks at 16% (±3.1%) WL, which deviated from greatest on-treatment WL and end-of-treatment WL by 2% (±0.7%) and 1% (±1.2%), respectively. Two studies assessed WR following drug discontinuation. In one trial, WR occurred 12 weeks after discontinuation and participants regained 65.9% of weight lost by end-of-study. In the other trial, WR occurred at 24 weeks, and participants regained 50%. CONCLUSION: This systematic review and meta-analysis characterizes the timeline of WL secondary to semaglutide with the intent to determine the ideal timing for BCS for patients with GLP-1-associated WL. Similar to post-bariatric surgery, our data suggests that BCS can be considered after 12-15 months of semaglutide use if the regimen is maintained. However, limited data show greater than 50% WR after drug discontinuation, which may distort BCS results. Surgeons should be cautious in undertaking patients with SaWL for BCS until more research is conducted to understand WR after discontinuation and the implications for plastic surgery. Data analysis is ongoing to investigate further differences by dose and indication.