Abstract
BackgroundMastectomy in the context of breast malignancy can have a profoundly negative impact on a woman’s self-image, impairing personal, sexual and social relationships. The deep inferior epigastric perforator (DIEP) flap and implants are the two commonest reconstructive modalities that can potentially overcome this psychological trauma. The comparative data on clinical outcomes and costs of the two modalities is limited. We aim to synthesise the current evidence on DIEP versus implants to establish which is the superior technique for breast reconstruction, in terms of clinical outcomes and cost-effectiveness.MethodsA comprehensive search will be undertaken of EMBASE, MEDLINE, Google Scholar, CENTRAL and Science citation index databases (1994 up to August 2017) to identify studies relevant for the review. Primary human studies evaluating clinical outcomes and cost of DIEP and implant-based reconstruction in context of breast malignancy will be included. Primary outcomes will be patient satisfaction and cosmetic outcome from patient-reported outcome measures (scores from validated tools, e.g. BREAST-Q tool), complications and cost-analysis. The secondary outcomes will be duration of surgery, number of surgical revisions, length of stay, availability of procedures and total number of clinic visits.DiscussionThis will be the first systematic review and meta-analysis in available literature comparing the clinical outcomes and cost-effectiveness of DIEP and implants for breast reconstruction. This review is expected to guide worldwide clinical practice for breast reconstruction.Systematic review registrationPROSPERO CRD42017072557.
Highlights
Mastectomy in the context of breast malignancy can have a profoundly negative impact on a woman’s self-image, impairing personal, sexual and social relationships
This systematic review is intended to evaluate the current evidence on the clinical outcomes and cost of deep inferior epigastric perforator (DIEP) flap versus implants for breast reconstruction post cancer-related mastectomy, to determine which technique is more cost-effective and clinically superior
If no randomised controlled trials (RCT) are available, the review will be reported according to the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines [26]
Summary
Mastectomy in the context of breast malignancy can have a profoundly negative impact on a woman’s self-image, impairing personal, sexual and social relationships. The deep inferior epigastric perforator (DIEP) flap and implants are the two commonest reconstructive modalities that can potentially overcome this psychological trauma. We aim to synthesise the current evidence on DIEP versus implants to establish which is the superior technique for breast reconstruction, in terms of clinical outcomes and cost-effectiveness. While mastectomy is the primary treatment modality for these patients, it can have a profoundly negative impact on their lives, impairing personal, sexual and social relationships. The two most frequently employed techniques include the autologous deep inferior epigastric perforator (DIEP) flap and implant-based reconstruction [11]. There is growing evidence to support increased aesthetic patient satisfaction with autologous flap reconstruction compared to implants, as well as increased suppleness and resiliency, especially in irradiated recipient beds [11,12,13,14,15,16,17,18,19]
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