{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T10:56:58Z","timestamp":1793271418254,"version":"4.5.0"},"reference-count":115,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003This meta-regression aims to investigate risk factors for abdominal hernia and bulge in patients undergoing deep inferior epigastric perforator (DIEP) flaps and the effect of prophylactic mesh placement on postoperative complications.<\/jats:p><jats:p>\n          Methods\u2003A systematic search was conducted in July of 2022 in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Seventy-four studies published between 2000 and 2022 met the inclusion criteria. Sixty-four studies were included in the analysis for bulge and 71 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\u2013Tukey double arcsine method.<\/jats:p><jats:p>\n          Results\u2003The average rates of hernia and bulge after DIEP flaps were found to be 0.18% and 1.26%, respectively. Increased age (\u03b2\u2009=\u20090.0059, p\u2009=\u20090.0117), prior abdominal surgery (\u03b2\u2009=\u20090.0008, p\u2009=\u20090.046), and pregnancy history (\u03b2\u2009=\u2009\u22120.0015, p\u2009=\u20090.0001) were significantly associated with hernia. Active smoking (\u03b2\u2009=\u20090.0032, p\u2009=\u20090.0262) and pregnancy history (\u03b2\u2009=\u20090.0019, p\u2009&lt;\u20090.0001) were significantly associated with bulge. Neither the perforator vessel laterality nor the number of perforator vessels harvested had any association with hernia or bulge. Prophylactic mesh placement was not associated with hernia or bulge.<\/jats:p><jats:p>\n          Conclusion\u2003Understanding the comorbidities associated with hernia or bulge following DIEP flap breast reconstruction, such as advanced age, prior abdominal surgery, pregnancy history, and active smoking status, allows surgeons to proactively identify and educate high-risk patients. Future studies may further explore whether prophylactic mesh placement offers patients any benefit.<\/jats:p>","DOI":"10.1055\/s-0044-1788564","type":"journal-article","created":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T23:48:45Z","timestamp":1721260125000},"page":"237-247","source":"Crossref","is-referenced-by-count":6,"title":["A DIEP Dive into Patient Risk Factors for Hernia and Bulge Development: A Meta-regression"],"prefix":"10.1055","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7124-0197","authenticated-orcid":false,"given":"Nikki","family":"Rezania","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3889-0689","authenticated-orcid":false,"given":"Kelly A.","family":"Harmon","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4136-6876","authenticated-orcid":false,"given":"Reilly","family":"Frauchiger-Ankers","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Okensama","family":"La-Anyane","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois"},{"name":"Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keid","family":"Idrizi","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jocelyn","family":"To","sequence":"additional","affiliation":[{"name":"Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethan M.","family":"Ritz","sequence":"additional","affiliation":[{"name":"Rush Biostatistics and Bioinformatics Core, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Kurlander","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Rush University Medical 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