Autologous dermal flap techniques beyond inferior dermal flap coverage in implant-based breast reconstruction: A systematic review
In brief
Wider dermal flap pedicles lower nipple necrosis to 0% versus up to 31%
A systematic review of 17 studies (357 patients, 535 breasts) found that autologous dermal flaps with broader pedicles consistently avoided nipple-areolar complex necrosis, while narrow pedicles showed necrosis rates as high as 31.5%. Non-nipple techniques had major complications up to 20%, but evidence remains retrospective and heterogeneous, underscoring the need for prospective trials.
- Journal
- European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Q1)
- Published
- 11 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Adam Boukind, Nicholas C Speller, Amy Liao, Sophia Chryssofos, Justin M Sacks, Saif Badran
- PMID
- 42594494
- DOI
- 10.1016/j.ejso.2026.112066
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (top studies of the week, 16 August 2026): Autologous dermal flap techniques beyond inferior dermal flap coverage in
Abstract
BACKGROUND: While inferior dermal flap (IDF) techniques are gaining popularity for implant-based reconstruction (IBBR), a range of autologous dermal flap (ADF) modifications have been described that serve purposes beyond standard implant coverage. METHODS: Following PRISMA guidelines, we systematically searched six databases from January 1, 2020, to July 22, 2025, for studies on autologous dermal flap applications beyond standard IDF coverage. We excluded free flaps, IDF-only, subpectoral-only, nipple-areolar complex-only, and ADM/synthetic mesh-based-only reconstructions. RESULTS: Out of 15,678 initial articles, 17 met the inclusion criteria encompassing 357 patients and 535 breasts across 12 retrospective studies, 3 case reports, 1 prospective case series, and 1 randomized controlled trial. Techniques identified included nipple-carrying autologous dermal flaps using various pedicle configurations, meshed autologous dermis, skin-island carrying flaps, contralateral dermal grafting, autodermal fillers, and combinatorial approaches. Major complication rates varied substantially by technique: complete NAC necrosis ranged from 0% to 31.5% depending on pedicle breadth, with broader pedicles consistently associated with lower necrosis rates. Major complications across non-nipple-carrying techniques ranged from 0% to 20%. CONCLUSIONS: This review identifies and categorizes a spectrum of autologous dermal flap modifications beyond standard inferior dermal flap coverage, demonstrating that broader pedicle configurations are consistently associated with reduced NAC necrosis rates. The overall evidence base remains retrospective and heterogeneous, and prospective trials incorporating patient-reported outcomes, cost analyses, and stratification by radiation exposure are needed to establish the role of these techniques relative to ADM and synthetic mesh in oncologic breast reconstruction.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.