{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T08:18:36Z","timestamp":1783066716439,"version":"3.54.6"},"reference-count":19,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPHS"],"abstract":"<jats:p>Background: Autologous breast reconstruction continues to be a cornerstone of post-mastectomy reconstruction, with abdominally based flaps providing reliable aesthetic and functional outcomes. Of these approaches, the deep inferior epigastric perforator (DIEP) flap and the transverse rectus abdominis myocutaneous (TRAM) flap are the most commonly used. However, controversy exists surrounding their relative effectiveness, complication profile, donor-site morbidity, and reported outcomes.\nMethods: A systematic review and meta-analysis were undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. A search was conducted across PubMed, Scopus, Embase, and Web of Science for comparative studies published between January 2000 and December 2025 that assessed DIEP and TRAM flap breast reconstruction. Outcomes included total flap loss, fat necrosis, donor-site morbidity, abdominal wall complications, and patient-reported outcomes. Random-effects meta-analyses were performed employing pooled odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity was evaluated by Cochran\u2019s Q and Higgins\u2019 I\u00b2 statistics. An exploratory network meta-analysis was also performed to compare DIEP with other autologous reconstructive techniques, such as transverse upper gracilis (TUG), transverse myocutaneous gracilis (TMG), profunda artery perforator (PAP), and inferior gluteal artery perforator (IGAP) flaps.\nResults: Ten studies met the inclusion criteria for the qualitative synthesis, yet five also provided quantitative data that were included in the meta-analysis. Pooled analysis showed no significant difference in fat necrosis between reconstructive techniques (OR: 0.86; 95% CI: 0.54\u20131.36; I\u00b2 = 34.6%). Likewise, the total flap loss rates were similar between DIEP and TRAM flaps (OR: 0.79; 95% CI: 0.39\u20131.61; I\u00b2 = 7.2%). DIEP reconstruction was consistently associated with fewer donor-site morbidities and significantly better maintenance of abdominal wall health than the TRAM flap. Among exploratory network meta-analysis studies, the TUG flap showed clear superiority in reduced total flap loss, while DIEP flaps ranked favorably in donor-site outcomes and patient satisfaction.\nConclusions: DIEP and TRAM flaps have comparable flap survival and overall reconstructive efficacy in post-mastectomy breast reconstruction. DIEP reconstruction appears to offer the best performance in reducing donor-site morbidity while preserving abdominal wall integrity. There was no single reconstruction technique that consistently outperformed all other reconstructive approaches across all outcomes, reinforcing an individualized surgical approach based on patient anatomy, comorbidities, reconstruction goals, and surgeon expertise.<\/jats:p>","DOI":"10.2340\/jphs.v61.46271","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T07:43:07Z","timestamp":1783064587000},"page":"174-181","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and donor-site outcomes of DIEP versus TRAM flaps in post-mastectomy breast reconstruction: a systematic review and meta-analysis"],"prefix":"10.2340","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5284-3022","authenticated-orcid":false,"given":"Jorge Andr\u00e9s","family":"Urquijo M\u00e9ndez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Rico-Mendoza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Porras-Ram\u00edrez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"161758","unstructured":"World Health Organization. Breast cancer fact sheet. Geneva: World Health Organization; 2021."},{"key":"161759","unstructured":"Atisha DM, Alderman AK, Lowery JC, et al. Prospective analysis of long-term psychosocial outcomes in autologous breast reconstruction. Ann Surg. 2015;261(5):971\u2013978."},{"key":"161760","doi-asserted-by":"crossref","unstructured":"Pusic AL, Klassen AF, Scott AM, et al. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg. 2009;124(2):345\u2013353.","DOI":"10.1097\/PRS.0b013e3181aee807"},{"key":"161761","doi-asserted-by":"crossref","unstructured":"Man LX, Selber JC, Serletti JM. Abdominal perforator flaps for breast reconstruction: a systematic review of outcomes. Plast Reconstr Surg. 2009;124(2):331\u2013339.","DOI":"10.1097\/PRS.0b013e31818b7533"},{"key":"161762","unstructured":"Klassen AF, Cano SJ, Scott AM, et al. Satisfaction and quality of life in women undergoing breast reconstruction: results from the BREAST-Q. Plast Reconstr Surg. 2014;134(4):587\u2013595."},{"key":"161763","doi-asserted-by":"crossref","unstructured":"Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg. 1994;32(1):32\u201338.","DOI":"10.1097\/00000637-199401000-00007"},{"key":"161764","doi-asserted-by":"crossref","unstructured":"Hartrampf CR Jr, Scheflan M, Black PW. Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg. 1982;69(2):216\u2013225.","DOI":"10.1097\/00006534-198202000-00007"},{"key":"161765","unstructured":"Selber JC, Nelson JA, Fosnot J, et al. A prospective study comparing outcomes between DIEP and free TRAM flaps for breast reconstruction. Plast Reconstr Surg. 2012;129(2):300\u2013309."},{"key":"161766","unstructured":"Nelson JA, Fischer JP, Cleveland E, Grover R, Serletti JM, Wu LC. Abdominal wall morbidity following DIEP versus TRAM flap breast reconstruction: a systematic review and meta-analysis. Plast Reconstr Surg. 2019;143(1):10\u201320."},{"key":"161767","unstructured":"Zhong T, Hu J, Bagher S, et al. A systematic review and meta-analysis comparing DIEP and TRAM flap breast reconstruction. Ann Plast Surg. 2020;84(3 Suppl 2):S197\u2013S203."},{"key":"161768","doi-asserted-by":"crossref","unstructured":"Gill PS, Hunt JP, Guerra AB, et al. A 10-year retrospective review of 758 DIEP flaps for breast reconstruction. Plast Reconstr Surg. 2004;113(4):1153\u20131160.","DOI":"10.1097\/01.PRS.0000110328.47206.50"},{"key":"161769","unstructured":"Khansa I, Momoh AO, Patel PP, et al. Fat necrosis in autologous breast reconstruction: a systematic review and meta-analysis. Plast Reconstr Surg. 2016;137(4):1124\u20131132."},{"key":"161770","unstructured":"Rozen WM, Ashton MW, Stella DL, et al. Planning and optimizing DIEP flaps with virtual surgery: the impact of computed tomographic angiography on perforator selection and operative efficiency. Microsurgery. 2008;28(4):261\u2013269."},{"key":"161771","unstructured":"Fischer JP, Cleveland E, Nelson JA, et al. A systematic review and meta-analysis of abdominally based autologous breast reconstruction techniques. J Plast Reconstr Aesthet Surg. 2019;72(8):1231\u20131241."},{"key":"161772","doi-asserted-by":"crossref","unstructured":"Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple graphical test. BMJ. 1997;315(7109):629\u2013634.","DOI":"10.1136\/bmj.315.7109.629"},{"key":"161773","unstructured":"Lee KT, Mun GH. A meta-analysis of studies comparing DIEP flap and muscle-sparing free TRAM flap for breast reconstruction. Ann Plast Surg. 2014;72(2):145\u2013151."},{"key":"161774","unstructured":"Thoma A, Khuthaila D, Rockwell G, Veltri K. Outcomes and donor-site morbidity following DIEP versus TRAM flap breast reconstruction: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2021;74(5):1023\u20131035."},{"key":"161775","unstructured":"Haddock NT, Teotia SS. Comparative outcomes of abdominal and gluteal perforator flaps or autologous breast reconstruction. Plast Reconstr Surg. 2020;145(4):815\u2013824."},{"key":"161776","unstructured":"Li Y, Zhang X, Wang J, Chen L, Zhao H. Network meta-analysis of autologous breast econstruction techniques: comparative effectiveness and patient-reported outcomes. Microsurgery. 2023;43(6):547\u2013558."}],"container-title":["Journal of Plastic Surgery and Hand Surgery"],"original-title":[],"link":[{"URL":"https:\/\/medicaljournalssweden.se\/JPHS\/article\/download\/46271\/54675","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/medicaljournalssweden.se\/JPHS\/article\/download\/46271\/54675","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T07:44:07Z","timestamp":1783064647000},"score":1,"resource":{"primary":{"URL":"https:\/\/medicaljournalssweden.se\/JPHS\/article\/view\/46271"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":19,"URL":"https:\/\/doi.org\/10.2340\/jphs.v61.46271","relation":{},"ISSN":["2000-6764"],"issn-type":[{"value":"2000-6764","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,3]]}}}