Wegovy, Mounjaro: Pre- and Post-Surgery Management for Patients

Hello,

This is Dr. J from Cheongdam SNU Plastic Surgery Clinic.

Recently, there has been a significant increase in plastic surgery consultations from individuals who are taking Wegovy (semaglutide) or Mounjaro (tirzepatide) for weight management.

While these obesity treatments offer excellent weight loss effects, special management is required before and after surgery.

Today, we will delve into when to discontinue and restart Wegovy or Mounjaro, depending on the type of surgery.

Why is it necessary to stop before surgery?

Wegovy and Mounjaro are GLP-1 receptor agonists, which have the characteristic of delaying gastric emptying.

Because of this, even after fasting before surgery, stomach contents may remain.

This can increase the risk of aspiration pneumonia during general anesthesia and raise the likelihood of vomiting or reflux during anesthesia.

Therefore, an appropriate discontinuation period is essential for safe surgery.

Discontinuation and Restart Guidelines by Surgery Type

🏥 General Anesthesia Surgery

(Abdominoplasty, Breast Surgery, Facelift, etc.)

Discontinuation Period:

Both Wegovy and Mounjaro should be stopped 7 days before surgery.

Restart Period:

Decision is made after 3-5 days post-surgery, when normal oral intake is possible, the surgical site is recovering well, and after consulting with the attending physician.

😴 Sedation Anesthesia Surgery

(Eye Surgery, Nose Surgery, Lifting, etc.)

Discontinuation Period:

Both Wegovy and Mounjaro should be stopped 3-5 days before surgery.

Restart Period:

Restart is recommended 2-3 days post-surgery, when normal eating is possible and there are no symptoms of vomiting or nausea.

💉 Local Anesthesia Procedures

(Botox, Fillers, Thread Lifts, etc.)

Discontinuation Period:

Generally, there is no need to discontinue.

However, it is recommended to maintain a fasting state on the day of the procedure.

Precautions:

Refrain from excessive food intake before/after the procedure, and if swelling or bruising occurs at the procedure site, consider its potential association with the medication.

📋 Patient-Specific Management Points

✅ For Diabetic Patients

- Closely monitor blood sugar levels.

- Consider interactions with insulin or other diabetes medications.

- Refer for collaborative care with an endocrinologist if necessary.

✅ Patients on High Doses

- If you are on the maximum dose of Mounjaro 15mg or Wegovy 2.4mg,

consider extending the discontinuation period by 1-2 days.

(A personalized schedule considering individual differences is necessary.)

✅ Patients on Long-Term Treatment

- If you have been taking the medication for more than 6 months,

the effect of delayed gastric emptying may persist longer.

A more thorough pre-operative evaluation will be conducted.

⚠️ Precautions and Complication Prevention

✅ Pre-operative Checklist:

- Confirm accurate medication history, including the last dose and date of administration,

- history of side effects,

- and concomitant use of other medications.

✅ Strict Adherence to Fasting Time:

An additional 2-4 hours of fasting beyond the usual time is required, and water intake is permitted until 3-4 hours before surgery.

✅ Monitoring for Warning Signs:

Monitor for persistent nausea, vomiting, abdominal distension, and indigestion symptoms.

✅ Post-operative Management:

Gradually resume eating in stages: clear liquids → soft porridge → soft foods → regular diet.

(Avoid a sudden increase in food intake.)

✅ Precautions When Restarting Medication:

Start with a low dose and gradually increase, observing for gastrointestinal side effects.

Adjust the restart time if necessary.

💡 Checklist for Consultation

📍 During Initial Consultation

- Confirm the name and dosage of current medications.

- Record the start date and last dose date.

- Inquire about any past side effect experiences.

- Inquire about other medication history.

- Establish a discontinuation plan based on the scheduled surgery date.

📍 Pre-operative Check

- Confirm adherence to the discontinuation period.

- Check fasting status.

- Evaluate gastrointestinal symptoms.

- Pre-discussion with the anesthesiologist or surgeon.

📍 Post-operative Management:

- Evaluate recovery status.

- Confirm progress of diet stages.

- Consult on medication restart plan.

- Provide guidance on future follow-up appointments.

🔍 Frequently Asked Questions (FAQ)

Q: What if I'm taking Wegovy and suddenly need surgery?

A: Unless it's an emergency surgery, it is safer to adhere to the recommended discontinuation period as much as possible.

In urgent cases, please consult thoroughly with the anesthesiologist and surgeon before proceeding.

Q: What if I gain weight during the discontinuation period?

A: Temporary weight gain is a natural phenomenon.

Don't worry, you can restart the medication once you recover from surgery.

Q: Do I need to inform other hospitals if I'm having surgery there?

A: Yes, you must inform them.

This is important information for any surgery that involves anesthesia.

Wegovy and Mounjaro are effective obesity treatments, but special care is required during surgery.

It is crucial to prioritize safety by establishing an appropriate discontinuation and restart plan.

If you have any questions, please feel free to consult us to receive personalized guidance tailored to your individual situation.

We will work together to ensure safe and successful surgical outcomes.

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