A DIEP Dive into Patient Risk Factors for Hernia and Bulge Development: A Meta-regression

Nikki Rezania; Kelly A. Harmon; Reilly Frauchiger-Ankers; Okensama La-Anyane; Keid Idrizi; Jocelyn To; Ethan M. Ritz; David E. Kurlander; Deana Shenaq; George Kokosis

doi:10.1055/s-0044-1788564

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2025; 41(03): 237-247
DOI: 10.1055/s-0044-1788564

Original Article

A DIEP Dive into Patient Risk Factors for Hernia and Bulge Development: A Meta-regression

Authors

Nikki Rezania

¹Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
Kelly A. Harmon

¹Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
Reilly Frauchiger-Ankers

¹Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
Okensama La-Anyane

¹Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois

³Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut
Keid Idrizi

¹Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
Jocelyn To

²Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
Ethan M. Ritz

⁴Rush Biostatistics and Bioinformatics Core, Rush University Medical Center, Chicago, Illinois
David E. Kurlander

¹Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
Deana Shenaq

¹Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
George Kokosis

¹Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois

Abstract

Background This 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.

Methods A 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–Tukey double arcsine method.

Results The average rates of hernia and bulge after DIEP flaps were found to be 0.18% and 1.26%, respectively. Increased age (β = 0.0059, p = 0.0117), prior abdominal surgery (β = 0.0008, p = 0.046), and pregnancy history (β = −0.0015, p = 0.0001) were significantly associated with hernia. Active smoking (β = 0.0032, p = 0.0262) and pregnancy history (β = 0.0019, p < 0.0001) 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.

Conclusion Understanding 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.

Keywords

autologous breast reconstruction - deep inferior epigastric perforator flap - bulge - hernia

Full Text

References

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