Massive Weight Loss with Bariatric Surgery and GLP-1RA Therapy Predicts Postoperative Complications Following Abdominal Body Contouring

Background . Body contouring patients increasingly utilize potent weight loss modalities, including bariatric surgery and glucagon-like peptide-1 receptor agonists (GLP-1RAs). This study assessed the effect of massive or rapid weight loss from high-potency weight loss modalities on abdominal body contouring outcomes. Methods . A retrospective cohort study was performed on patients who underwent abdominal body contouring surgery at a large academic institution between 2013 and 2025. Patients were stratified by preoperative weight loss from bariatric surgery, GLP-1RAs, or combined bariatric surgery/GLP-1RAs. Preoperative weights were extracted, and postoperative complications were compared between cohorts. Results . 552 patients were included. Patients using combined bariatric surgery/GLP-1RAs (28.6%) and bariatric surgery alone (24.1%) had the highest total body weight loss percentages (TBWL%). Patients with combined bariatric surgery/GLP-1RA use had the highest rate of weight loss at 0.95% TBWL per month. Irrespective of weight loss modality, a higher magnitude of weight loss was predictive of seroma (OR 1.05 [1.02-1.08], p=0.004) and composite complications (OR 1.03 [1.01-1.05], p=0.017) on multivariable regression. Higher weight loss rate was also predictive of postoperative seroma (OR 2.64 [1.26-5.60], p=0.010). Combined bariatric surgery/GLP-1RA use was predictive of seroma (OR 3.05 [1.02-8.08], p=0.032), hematoma (OR 3.74 [1.02-13.76], p=0.047), and unplanned return to the operating room (OR 6.78 [2.42-17.99], p<0.001). Conclusions . Massive or rapid weight loss prior to abdominal body contouring surgery is predictive of postoperative complications. Patients with combined bariatric surgery and GLP-1RA use have the highest degree and rate of weight loss and subsequently experience higher complication rates.