Deep Inferior Epigastric Perforator Flap Breast Reconstruction in Patients With or Without Previous Abdominal...

The deep inferior epigastric perforator (DIEP) flap is now considered the gold standard for autologous breast reconstructions (BRs). Previous abdominal surgery (PAS) is considered to be a potential contraindication to abdominal-based BR. This systematic review and meta-analysis aim to evaluate the impact of PAS following a DIEP flap BR comparing patients with or without PAS.

A systematic review of the literature and comparative meta-analysis were performed to assess the differences in abdominal donor-site and flap complication rates between patients with or without PAS. Only comparative studies that reported on postoperative complications following DIEP flap BR were included. Odds ratios and 95% confidence intervals were calculated using a random-effects model.

Nine studies were included, representing 2440 patients with or without PAS corresponding to 3082 DIEP flap BR. There were no differences across groups in flap-related complication rates. However, PAS was associated with an increase in the overall rate of abdominal complications (odds ratio = 1.92; 95% confidence interval = 1.41-2.62; P < 0.0001).

PAS is not a contraindication to DIEP flap BR, and no increase in the flap complication rate has been found in association with PAS. However, our study shows that PAS is associated with a higher overall abdominal complication rate at the donor site.