Donor-site Seroma in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Pooled Analysis

Seroma at the abdominal donor site is a recognized complication following deep inferior epigastric perforator (DIEP) flap breast reconstruction. Reported incidences vary widely, reflecting differences in surgical technique, patient characteristics, and outcome reporting. Consequently, this proportional meta-analysis aims to estimate the pooled incidence of abdominal donor-site seroma and evaluate potential risk factors associated with its occurrence.

A systematic literature review of PubMed, Web of Science, and the Cochrane Library was performed up to June 2025. Studies reporting abdominal donor-site seroma rates following DIEP flap reconstruction were included. Data were pooled using a random-effects model (DerSimonian-Laird), and heterogeneity was assessed using I ² and τ² statistics. Univariable meta-regression analyses explored associations of smoking status and diabetes with seroma occurrence.

The search identified 1345 unique records, of which 71 studies met the inclusion criteria, comprising 12,739 patients and 16,915 DIEP flaps. A total of 736 seromas were reported, yielding a pooled incidence of 6% (95% confidence interval, 4%-7%). Heterogeneity was substantial (I ² = 85.3%, τ² = 0.05, P < 0.001). The mean body mass index and age were 27.2 kg/m² and 50.4 years, respectively. Meta-regression showed no significant association between seroma occurrence and smoking (P = 0.57) or diabetes (P = 0.07).

Donor-site seroma occurs in 6% of DIEP flap reconstructions. The absence of associations with smoking or diabetes in meta-regression suggests that seroma formation may be influenced by technical and perioperative factors rather than by comorbidities.