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. 2024 Dec 5;12(12):e6359.
doi: 10.1097/GOX.0000000000006359. eCollection 2024 Dec.

Unilateral Versus Bilateral Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review and Meta-analysis

Boran Tekdogan  1 , Jérôme Martineau  1 , Daniel F Kalbermatten  1 , Carlo M Oranges  1
Affiliations

Unilateral Versus Bilateral Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review and Meta-analysis

Boran Tekdogan et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: Previous studies have shown a higher complication rate in bilateral (BL) compared to unilateral (UL) deep inferior epigastric perforator (DIEP) flap breast reconstructions. This systematic review and meta-analysis aimed to offer an update by including recent studies to thoroughly assess the complication rates in UL versus BL DIEP flap reconstructions and provide clear guidance for clinicians and their patients.

Methods: A systematic review of the literature and comparative meta-analysis were performed to assess the differences in complication rates between UL and BL procedures. Only comparative studies that reported on postoperative complications after UL and BL DIEP flap breast reconstructions were included. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model.

Results: Five studies representing 5120 patients who underwent either UL or BL DIEP flap breast reconstructions were included. BL DIEP flap reconstructions were associated with a higher risk of total flap loss, with an OR of 1.48 (95% CI, 1.02-2.14) and a P value of 0.04. Conversely, the risk of reexploration surgery was reduced, with an OR of 0.68 (95% CI, 0.55- 0.84) and a P value of 0.0002.

Conclusions: BL DIEP flap breast reconstruction carries a higher risk of complete flap loss compared with UL reconstructions, with a moderate risk increase. Despite this increased risk, the significant benefits of BL reconstruction make it a viable and recommended option for women requiring this type of surgery.

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Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
PRISMA flowchart.
Fig. 2.
Fig. 2.
Pooled total flap loss rate.
Fig. 3.
Fig. 3.
Pooled reexploration rate.
Fig. 4.
Fig. 4.
Pooled partial flap loss rate.
See this image and copyright information in PMC

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