DIEP versus SIEA flap in autologous breast reconstruction: A systematic review and meta-analysis
In brief
SIEA breast flaps had over fivefold higher odds of total flap loss than DIEP flaps
In a meta-analysis of 19 studies, SIEA flaps had higher odds of total flap loss and return to surgery for blood-flow problems, mainly arterial insufficiency. They were linked to fewer abdominal bulges or hernias but more donor-site seromas, with no sustained advantage in patient-reported outcomes. The findings favor DIEP flaps for vascular reliability, though prospective studies are needed.
- Journal
- Journal of plastic, reconstructive & aesthetic surgery : JPRAS (Q1)
- Published
- 8 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Marco Morelli Coppola, Beniamino Brunetti, Carolina P Mureddu, Anna Scarabosio, Giulio J Jaber, Pietro G di Summa, et al.
- PMID
- 42925712
- DOI
- 10.1016/j.bjps.2026.09.050
Why clinicians should know about it
- Picked for Plastic and Reconstructive Surgery (paper of the day, 26 October 2026): Comparative autologous breast flap survival and donor-site outcomes
Abstract
INTRODUCTION: Although the deep inferior epigastric artery perforator (DIEP) flap is regarded as the gold standard in autologous breast reconstruction (ABR), the superficial inferior epigastric artery (SIEA) flap has been proposed as a muscle- and fascia-sparing alternative. However, evidence comparing outcomes between these techniques continues to be heterogeneous and controversial. METHODS: A systematic review and meta-analysis were conducted according to the PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420251149245). The PubMed/MEDLINE, Embase, Scopus and the Cochrane Library databases were searched from inception to September 16, 2025. Comparative studies that evaluated SIEA and DIEP flaps in ABR were included. Primary outcomes included total flap loss, partial flap loss and take-back for vascular compromise. Secondary outcomes included abdominal bulge/hernia, seroma, liponecrosis and patient-reported outcome measures (PROMs). Random-effects meta-analyses were performed. RESULTS: Nineteen studies were included. SIEA flaps were associated with significantly higher odds of total flap loss (OR 5.42, 95% CI 2.76-10.63; p = 0.0009) and take-back for vascular compromise (OR 3.80, 95% CI 2.50-5.76; p = 0.002), which was driven primarily by increased arterial insufficiency. Venous congestion did not differ significantly between the techniques. Donor-site seroma occurred more frequently after SIEA harvest (OR 5.31, 95% CI 2.94-9.61; p = 0.003), whereas abdominal bulge and hernia occurred less frequently in the SIEA group (OR 0.26, 95% CI 0.08-0.84; p = 0.04). PROMs showed no sustained advantage in using SIEA flaps. CONCLUSIONS: Across the literature, the DIEP flap demonstrated superior vascular reliability, compared with the SIEA flap. Therefore, the SIEA flap should be reserved for carefully selected patients with favourable anatomy and adequate vessel calibre. Further prospective studies using standardised outcomes and validated PROMs are warranted. LEVEL OF EVIDENCE: Level III.
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.