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Review
. 2022 Sep 1;14(17):4272.
doi: 10.3390/cancers14174272.

Complications of Immediate versus Delayed DIEP Reconstruction: A Meta-Analysis of Comparative Studies

André S Alves  1 , Vincent Tan  1 , Matteo Scampa  1 , Daniel F Kalbermatten  1 , Carlo M Oranges  1
Affiliations
Review

Complications of Immediate versus Delayed DIEP Reconstruction: A Meta-Analysis of Comparative Studies

André S Alves et al. Cancers (Basel). .

Abstract

Purpose: The setting regarding the ideal timing for deep inferior epigastric perforator flap (DIEP) reconstruction remains unclear. Immediate breast reconstruction (IBR) is performed at the same time as mastectomy, while delayed breast reconstruction (DBR) is performed at any time after mastectomy except immediately. We compared both strategies to assess whether IBR or DBR should be performed to reduce postoperative adverse events.

Methods: A systematic review of PubMed, Embase, Medline, Cochrane, and Web of Science was conducted, aiming at articles comparing the recipient site outcomes of IBR versus DBR with DIEP. We used the Mantel-Haenszel method with a fixed effects model. Results were expressed as the OR with a 95% CI.

Results: Two retrospective and two prospective studies were identified involving 5784 DIEPs (1744 immediate and 4040 delayed). We showed a significant difference in favor of IBR for wound healing issues (OR = 0.57, 95% CI 0.41, 0.77; p = 0.0003). However, no significant differences for hematoma, infection, fat necrosis, partial flap loss, and total flap loss rate were seen.

Conclusions: Despite variability in the choice of the ideal time for breast reconstruction and outcomes reported among studies, immediate DIEP surgery appears to be a reliable setting with less delayed healing issues.

Keywords: DIEP; adverse events; autologous reconstruction; delayed breast reconstruction; free flap; immediate breast reconstruction; radiotherapy; surgical timing.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Time options for breast reconstruction. RT = radiotherapy; DIEP = deep inferior epigastric perforator flap.
Figure 2
Figure 2
Flow diagram of search for eligible studies.
Figure 3
Figure 3
Combined ORs to assess effect of immediate versus delayed DIEP on adverse events for minor complication: (1.1) wound healing, (2.1) hematoma, (3.1) infections, and (4.1) fat necrosis [8,9,14,19]. Blue shapes correspond to individual studies. Squares size is proportional to the weight of the study while black diamonds shapes correspond to pooled studies.
Figure 4
Figure 4
Combined ORs to assess effect of immediate versus delayed DIEP on adverse events for major complications: (5.1) total flop loss, and (5.2) partial flap loss [8,9]. Blue shapes correspond to individual studies. Squares size is proportional to the weight of the study while black diamonds shapes correspond to pooled studies.
Figure 5
Figure 5
Funnel plot of comparison of adverse events for wound.
See this image and copyright information in PMC

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