A Meta-analysis Comparing Deep Inferior Epigastric Perforator Flaps and Latissimus Dorsi Flaps in Breast Reconstruction.

BACKGROUND

Deep inferior epigastric perforator (DIEP) flaps and latissimus dorsi (LD) flaps are two widely used breast reconstruction techniques, each with distinct advantages and limitations. This meta-analysis aims to compare patient satisfaction and incidence of complications between these two techniques to inform clinical decision-making.

METHODS

PubMed, Scopus, and Web of Science were searched for relevant studies. We included studies with data comparing DIEP and LD flaps, BREAST-Q patient satisfaction, and complications. Statistical analyses were performed using RevMan 5.4.

RESULTS

The search yielded 788 studies, of which 13 were included in the meta-analysis. A total of 2128 patients were analyzed, with 1378 undergoing DIEP flap reconstruction and 750 receiving LD flap reconstruction. The analysis showed greater improvement with DIEP flaps in breast satisfaction [mean difference (MD) = 9.48, 95% confidence interval (CI) = 6.90-12.05,  < 0.00001], physical well-being (MD = 5.95, 95% CI = 2.98-8.92,  < 0.0001), and satisfaction with outcome (MD = 9.36, 95% CI = 3.01-15.71,  = 0.004). Nonetheless, DIEP flaps had higher rates of skin flap necrosis [risk ratio (RR) = 4.27, 95% CI = 2.44 to 7.46, < 0.00001], wound dehiscence (RR = 5.12, 95% CI = 2.53-10.35,  < 0.00001), and reoperation (RR = 2.24, 95% CI = 1.58 -3.16, < 0.00001) but lower seroma rates (RR = 0.27, 95% CI = 0.10-0.74,  = 0.01).

CONCLUSIONS

DIEP flap reconstruction offers superior patient satisfaction compared with LD flap reconstruction, despite a higher incidence of certain complications.