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Updated: Jun 30, 2026
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Comparative Outcomes of Deep Inferior Epigastric Perforator Flap and Breast Implants in Breast Reconstruction
Jose Manuel Garcia-Romero1, Alexis Vazquez-Martinez2, Filippo Taccioli3
1From the Department of Medicine, Autonomous University of Queretaro, Queretaro, Mexico.
Background:
Breast reconstruction after mastectomy can restore body image and improve quality of life. Implant-based reconstruction (IBR) offers shorter operative times without donor-site morbidity, whereas deep inferior epigastric perforator (DIEP) flaps may provide more natural outcomes. This systematic review compares outcomes of DIEP flaps and IBR.
Methods:
A systematic search of MEDLINE, CENTRAL, and Google Scholar was performed in June 2025 (PROSPERO ID: CRD420251081966) for studies comparing DIEP flaps and IBR after mastectomy. Studies reported BREAST-Q scores and complications, reconstruction failures, and revision procedures. Risk of bias was assessed using Cochrane RoB 2.0 for randomized trials and ROBINS-I for nonrandomized studies, with evidence graded using Grading of Recommendations, Assessment, Development, and Evaluations. Pooled mean differences and odds ratios with 95% confidence intervals were calculated.
Results:
Twenty studies including 3106 patients (1068 DIEP and 2038 IBR) were analyzed. DIEP flap group showed higher overall BREAST-Q scores (mean difference +9.28; P = 0.008), with improvements in breast satisfaction, psychosocial well-being, and sexual well-being. Nipple satisfaction and chest physical well-being showed no significant differences. Infection, hematoma, and seroma rates were comparable. DIEP flap had lower reconstruction failure rate (odds ratio 0.15; P = 0.019), although donor-site morbidity and revision rates were higher. Anxiety and depression outcomes showed no significant differences.
Conclusions:
DIEP flap reconstruction offers better patient satisfaction and lower failure rates than IBR, without increased complications. These benefits must be weighed against operative complexity and resource demands. High-quality multicenter trials with standardized outcome reporting are needed for patient-centered decisions.
