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

Plast Reconstr Surg Glob Open

From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, Geneva, Switzerland.

Published: December 2024

AI Article Synopsis

  • - This systematic review analyzes complication rates in bilateral (BL) versus unilateral (UL) deep inferior epigastric perforator (DIEP) flap breast reconstructions, noting that prior studies indicated higher complications for BL procedures.
  • - The analysis included five studies with a total of 5,120 patients, revealing that BL reconstructions have a 48% higher risk of total flap loss (OR 1.48) but a lower risk of needing reexploration surgery (OR 0.68).
  • - Despite the increased risk of flap loss in BL reconstructions, the overall benefits make it a recommended choice for women undergoing breast reconstruction.

Article 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 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 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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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11620719PMC
http://dx.doi.org/10.1097/GOX.0000000000006359DOI Listing

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