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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u20132.90;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.05) and wound revisions (RR 1.23; 95% CI 1.01\u20131.50;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.04). Pre-DIEP radiotherapy significantly increased the risk of wound healing disturbances (RR 1.62; 95% CI 1.06\u20132.49;\n                      <jats:italic>P<\/jats:italic>\n                      = 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 \u2212\u20096.49; 95% CI \u2212\u200911.79 to \u2212\u20091.19;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.02).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence I<\/jats:title>\n                    <jats:p>\n                      This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors \u00a0\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.springer.com\/00266\" ext-link-type=\"uri\">www.springer.com\/00266<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00266-026-05690-w","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T17:28:48Z","timestamp":1773250128000},"page":"3998-4008","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Impact of Radiotherapy on the Outcomes of Deep Inferior Epigastric Artery Perforator Flaps for Breast Reconstruction: A Systematic Review and Meta-Analysis"],"prefix":"10.1007","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7701-2171","authenticated-orcid":false,"given":"Ali Mohamed","family":"Elameen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Ibrahim","family":"Yassin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"5690_CR1","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1007\/s10549-018-5018-1","volume":"173","author":"MM Jonczyk","year":"2019","unstructured":"Jonczyk MM, Jean J, Graham R, Chatterjee A. 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