title: When is the deep inferior epigastric artery flap indicated for breast reconstruction in patients not treated with radiotherapy?
abstract: BACKGROUND
  It is controversial whether breast reconstruction with a microvascular free flap should be done without restrictions in patients who have not had radiotherapy. Many regard it as too expensive, but some consider it better and more economically advantageous than an implant reconstruction.
  
  
  METHODS
  Databases of publications were searched to find out under what conditions is it suitable to offer a deep inferior epigastric perforator (DIEP) or a transverse rectus abdominis myocutaneous flap to normalize the body's appearance in a woman whose breast(s) had been removed for cancer or to prevent the development of breast cancer. The effect of breast reconstruction with DIEP flaps was analyzed, taking account of the following factors: general satisfaction (quality of life), aesthetic satisfaction (cosmesis), and morbidity. To find out which factors were of potential importance, we recorded age, hypertension, whether scars from previous abdominal surgery were present, microcirculation, whether the patient was overweight or obese, and costs of the procedure.
  
  
  RESULTS
  Patients planning to have DIEP flaps should be willing to stop smoking at least 4 weeks before and after the procedure and have a body mass index of less than 30 kg/m to avoid a higher risk of complications. Because of the paucity of papers, it is difficult to recommend one approach over the other when considering general satisfaction, aesthetic satisfaction, and health economics. However, economical long-term outcome is highly dependent on the initial costs of each procedure and the cumulative costs of complications for each reconstruction method.
  
  
  CONCLUSIONS
  The scientific foundation of assessment of methods of techniques of breast reconstruction is weak. Therefore, it is important that future studies should present more comparable series, highlight the long-term effects in high-quality studies, to provide the patients with optimal results without undue risks and to avoid financial burdens on society.
authors.affiliation: From the Departments of *Plastic Surgery and †Oncology, Sahlgrenska University Hospital, Gothenburg; ‡Department of Plastic and Reconstructive Surgery, Skåne University Hospital and Lund University, Malmö; Departments of §Breast Surgery and ∥Oncology, Breast-Sarcoma Section, Karolinska University Hospital, Stockholm; and ¶Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Lundberg
authors.forename: Andri
authors.initials: A
authors.lastname: Thorarinsson
authors.forename: Per
authors.initials: P
authors.lastname: Karlsson
authors.forename: Anita
authors.initials: A
authors.lastname: Ringberg
authors.forename: Jan
authors.initials: J
authors.lastname: Frisell
authors.forename: Thomas
authors.initials: T
authors.lastname: Hatschek
authors.forename: Ann-Christine
authors.initials: AC
authors.lastname: Källström
authors.forename: Anna
authors.initials: A
authors.lastname: Elander
mesh_terms: D015992:Body Mass Index; D019928:Breast Implantation; D001943:Breast Neoplasms / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D050177:Overweight / Q000453:epidemiology; D017060:Patient Satisfaction; D011788:Quality of Life; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation; D035441:Thoracic Wall / Q000528:radiation effects