PURPOSE: This meta-analysis aims to investigate risk factors for abdominal hernia and bulge in patients undergoing DIEP flaps and the effect of prophylactic mesh placement on postoperative complications. METHODS: A systematic search was conducted in July, 2022 in alignment with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. 87 studies published between 2000 and 2022 met the inclusion criteria. 64 studies were included in the analysis for bulge and 72 studies were included in the analysis for hernia. Meta-regressions were run on the proportion of patients experiencing hernia or bulge to assess for patient risk factors and the role of prophylactic mesh placement. Proportions were transformed using the Freeman-Tukey double arcsine method. RESULTS: Increased age (β = 0.0058, p = 0.0145) and pregnancy history (β=-0.0015, p=0.0001) were significantly associated with hernia. Percentage of active smokers (β=0.003, p=0.0361) and pregnancy history (β= 0.0018, p<0.0001) were significantly associated with bulge. Having both medial and lateral perforators harvested during the procedure was significantly associated with a decreased incidence of bulge (β=-0.0039, p=0.0472). Prophylactic mesh placement did not seem to have any effect on hernia or bulge rates. CONCLUSION: Understanding the morbidities associated with DIEP flap breast reconstruction, such as advanced age, pregnancy history, and smoking status, allows surgeons to proactively identify high-risk patients for abdominal hernia or bulge and prepare for a potential repair. Future studies may further explore whether patients may benefit from prophylactic mesh placement.