Complications of Immediate versus Delayed DIEP Reconstruction: A Meta-Analysis of Comparative Studies

Abstract

Purpose: The setting regarding the ideal timing for deep inferior epigastric perforator flap (DIEP) reconstruction remains unclear. Immediate breast reconstruction (IBR) is performed at the same time as mastectomy, while delayed breast reconstruction (DBR) is performed at any time after mastectomy except immediately. We compared both strategies to assess whether IBR or DBR should be performed to reduce postoperative adverse events. Methods: A systematic review of PubMed, Embase, Medline, Cochrane, and Web of Science was conducted, aiming at articles comparing the recipient site outcomes of IBR versus DBR with DIEP. We used the Mantel–Haenszel method with a fixed effects model. Results were expressed as the OR with a 95% CI. Results: Two retrospective and two prospective studies were identified involving 5784 DIEPs (1744 immediate and 4040 delayed). We showed a significant difference in favor of IBR for wound healing issues (OR = 0.57, 95% CI 0.41, 0.77; p = 0.0003). However, no significant differences for hematoma, infection, fat necrosis, partial flap loss, and total flap loss rate were seen. Conclusions: Despite variability in the choice of the ideal time for breast reconstruction and outcomes reported among studies, immediate DIEP surgery appears to be a reliable setting with less delayed healing issues.

Technical consideration for breast reconstruction in patients requiring neoadjuvant or adjuvant radiotherapy: a narrative review

“…The detrimental effects of ART on autologous tissue do not depend on the time of reconstruction ( 89 , 90 ). Lower, even comparable, rates of complications have been reported in patients who underwent immediate A-BBR compared to delayed-immediate reconstructions, with a similar overall satisfaction rate observed in both groups ( 25 , 91 ). Some authors have reported higher revisional surgeries associated with immediate procedures (OR =0.15; 95% CI: 0.05–0.48; P<0.001) ( 92 ).…”

Unveiling Intricacies of DIEP Breast Reconstruction Post Early Breast Cancer: A Deep Dive into a Case of Unforeseen Complications

“…According to certain datasets, the failure rate of these free perforator flaps has been constrained to approximately less than 5%. 10 , 11 This noteworthy achievement is primarily attributable to advancements in surgical techniques and postoperative care. The challenges encountered during these procedures can be broadly categorized into two primary issues: inadequate arterial blood supply and venous stasis.…”