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

Abstract

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, P < 0.00001], physical well-being (MD = 5.95, 95% CI = 2.98–8.92, P < 0.0001), and satisfaction with outcome (MD = 9.36, 95% CI = 3.01–15.71, P = 0.004). Nonetheless, DIEP flaps had higher rates of skin flap necrosis [risk ratio (RR) = 4.27, 95% CI = 2.44 to 7.46, P < 0.00001], wound dehiscence (RR = 5.12, 95% CI = 2.53–10.35, P < 0.00001), and reoperation (RR = 2.24, 95% CI = 1.58 -3.16, P < 0.00001) but lower seroma rates (RR = 0.27, 95% CI = 0.10–0.74, P = 0.01). Conclusions: DIEP flap reconstruction offers superior patient satisfaction compared with LD flap reconstruction, despite a higher incidence of certain complications.