The Impact of Radiotherapy on the Outcomes of Deep Inferior Epigastric Artery Perforator Flaps for Breast Reconstruction: A Systematic Review and Meta-Analysis.

BACKGROUND

The deep inferior epigastric artery (DIEP) perforator flap is the primary reconstructive approach for autologous breast reconstruction. It is associated with minimal donor site complications and acceptable aesthetic outcomes for both the abdomen and breast. This meta-analysis evaluated the impact of radiotherapy on the DIEP flap for patients with autologous breast reconstruction.

METHODS

All clinical studies involving patients who underwent DIEP flap breast reconstruction and compared the outcomes of irradiated and non-irradiated breasts were included. A comprehensive literature search was performed across 12 databases up to May 18, 2025.

RESULTS

Eight studies including 4,447 patients (4478 flaps) were analyzed, of whom 1,624 received radiotherapy. Radiotherapy was associated with higher risks of partial flap loss (RR 1.69; 95% CI 0.99-2.90; P = 0.05) and wound revisions (RR 1.23; 95% CI 1.01-1.50; P = 0.04). Pre-DIEP radiotherapy significantly increased the risk of wound healing disturbances (RR 1.62; 95% CI 1.06-2.49; P = 0.03). No statistically significant differences were observed in flap volume change, total flap loss, flap contracture, fat necrosis, recipient-site infection, or the need for reconstructive adjustments. There was a significant lower total breast satisfaction score among irradiated breasts (MD - 6.49; 95% CI - 11.79 to - 1.19; P = 0.02).

CONCLUSIONS

Radiotherapy adversely affects surgical and patient-reported outcomes following DIEP flap autologous breast reconstruction, with pre-DIEP radiotherapy significantly increasing the risk of wound healing disturbances and post-DIEP radiotherapy associated with reduced overall breast satisfaction.

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