DOI: 10.1097/gox.0000000000007777 ISSN: 2169-7574

Comparative Outcomes of Deep Inferior Epigastric Perforator Flap and Breast Implants in Breast Reconstruction Postmastectomy: A Systematic Review and Meta-analysis

Jose Manuel Garcia-Romero, Alexis Vazquez-Martinez, Filippo Taccioli, Pablo Hernandez-Guillen, Matthew Griffiths, Oscar F. Fernandez-Diaz
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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.

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