Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, is among the five FDA-approved anti-obesity medications for long-term use. One study reported an average weight loss of 6% by 3 months and 12% by 7 months on semaglutide.

Ghusn W, De la Rosa A, Sacoto D, et al. Weight loss outcomes associated with semaglutide treatment for patients with overweight or obesity. JAMA Netw Open. 2022;5(9):e2231982.

 

Unfortunately for some, the rapid loss of fat throughout the body can result in the reduction of subcutaneous fat in unexpected areas, such as the face, leading to what has been dubbed "Ozempic face" by Dr. Paul Jarrod Frank, a celebrity dermatologist.

Humphrey CD, Lawrence AC. Implications of Ozempic and other semaglutide medications for facial plastic surgeons. Facial Plast Surg. 2023;39(6):719–721.

 

 

 

Defining ‘Ozempic breasts’

 

Semaglutide-induced rapid weight reduction can cause sudden and unexpected changes in breast size and shape, known colloquially as Ozempic breasts. 

“Typically, Ozempic breasts mimic postpartum breasts with decreased fullness and increased sag, or ptosis,” board-certified plastic surgeon Aaron Gilson, DO, tells MDLinx. Clinically, breast ptosis is characterised by sagging and shrinking of the breasts, with the nipple descending inferiorly below the breast fold and excess skin in the lower pole of the breast.

Martinez AA, Chung S. Breast ptosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Updated November 12, 2023.

 

While anecdotal reports suggest an association between Ozempic use and changes in breast volume, definitive research is currently unavailable. 

 

Adipose tissue reduction

 

Semaglutide promotes weight loss by enhancing satiety, reducing food cravings, and lowering calorie intake.

Although specific data on breast adipose tissue loss due to semaglutide is lacking, these effects are similar to those observed after bariatric surgery. Studies on bariatric surgery provide some insight; for example, the Journal of Obesity Surgery reports that women lose an average of 39.4% of their breast volume following major weight loss surgery.

Vohra NA, Kachare SD, Vos P, et al. The short-term effect of weight loss surgery on volumetric breast density and fibroglandular volume. Obes Surg. 2017;27(4):1013–1023.

 

According to Dr. Gilson, some groups of patients are at a higher risk of developing Ozempic breasts than others. These include women with larger breasts at baseline, patients with significant weight loss goals, and older patients who typically have less skin elasticity, making changes in breast volume more visible as sagging or ptosis. 

Additionally, patients with fibrocystic breasts may notice that benign lumps become more apparent as the surrounding tissue decreases.

 

In the clinic

 

Dr. Gilson suggests that “targeting and building the pectoralis and chest muscles can help maintain the appearance of some breast volume.” 

Additionally, maintaining a high-protein diet from the onset of semaglutide therapy can support muscle mass and body composition, further reducing the risk of sagging breasts.

Encourage patients to wear a supportive bra throughout the day to minimise the stretching of breast ligaments and gravitational sagging. Gentle breast massages can also promote circulation.

An alternative approach could involve the use of low-dose semaglutide. A 2024 cohort study of overweight or obese patients with type 1 diabetes mellitus demonstrated that low-dose semaglutide (0.5 mg per week) led to an average weight reduction of 11% after 6 months of therapy, making it a viable option for gradual weight loss.

Grassi BA, Onetto MT, Sánchez C, et al. Effect of low dose semaglutide in people with type 1 diabetes and excess weight. Diabetes Res Clin Pract. 2024;209:111593.

 

Furthermore, semaglutide's effects tend to wane after discontinuation, with patients often regaining about two-thirds of their original weight within a year—a phenomenon termed "Ozempic rebound."

Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553–1564.

 

For interventional management, refer patients to a qualified plastic surgeon for procedures such as mastopexy, breast augmentation, and lift with implants. Ensure the patient’s weight is stable before they proceed with any surgical intervention to avoid rebound weight gain, and make sure to help them set realistic expectations.