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

Abstract

Introduction: For two decades, autologous breast reconstruction, based on the deep inferior epigastric perforator flap (DIEP) procedure, has been widely adopted due to its natural aesthetic shape results. However, an ill-defined subject endures regarding the ideal time for surgery and the implication of this decision on postoperative complications. Immediate breast reconstruction (IBR) is performed at the same time of mastectomy while delayed breast reconstruction (DBR) is performed at any time after mastectomy except immediately. In our study, we compared both strategies to assess whether IBR or DBR should be done to reduce postoperative adverse events. Materials and Methods: According to the PRISMA guidelines, we conducted a meta-analysis on comparative adverse events studies of Immediate versus Delayed DIEP reconstruction. The following databases were used to identify suitable studies: PubMed, Embase, Medline, Cochrane, and Web of Science. Results: Two retrospective and two prospective studies were identified involving 5784 DIEP (1744 immediate and 4040 delayed) and reported the following adverse events: 1) Wound healing issue 2) Hematoma 3) Infection 4) Fat necrosis and 5) Partial or total Flap loss. The meta-analysis showed a significant difference in favour of IBR for wound healing (OR = 0.57, 95%CI [0.41, 0.77]; p = 0.0003) but not for hematoma (OR = 1.46, 95%CI [0.45, 4.77]; p = 0.53), infection (OR = 0.81, 95%CI [0.52, 1.25]; p = 0.34), fat necrosis (OR = 0.71, 95%CI [0.47, 1.05]; p = 0.09), partial flap loss (OR = 0.77, 95%CI [0.48, 1.24]; p = 0.28) and total flap loss (OR = 1.04, 95%CI [0.69, 1.58]; p = 0.85). Conclusion: This meta-analysis provided new knowledge regarding adverse events depending on the time procedure. This study only revealed a statistically significant higher wound healing issue (p=0.0003) in delayed breast reconstruction probably linked to complex care processes where radiation or chemotherapy are more frequent and could interfere in this setting.