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Systematic Reviews
Published in: Systematic Reviews 1/2017

Open Access 01-12-2017 | Protocol

Protocol for a systematic review and meta-analysis on the clinical outcomes and cost of deep inferior epigastric perforator (DIEP) flap versus implants for breast reconstruction

Authors: Ankur Khajuria, Oliver J. Smith, Maxim Prokopenko, Maximillian Greenfield, Afshin Mosahebi

Published in: Systematic Reviews | Issue 1/2017

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Abstract

Background

Mastectomy in the context of breast malignancy can have a profoundly negative impact on a woman’s self-image, impairing personal, sexual and social relationships. The deep inferior epigastric perforator (DIEP) flap and implants are the two commonest reconstructive modalities that can potentially overcome this psychological trauma. The comparative data on clinical outcomes and costs of the two modalities is limited. We aim to synthesise the current evidence on DIEP versus implants to establish which is the superior technique for breast reconstruction, in terms of clinical outcomes and cost-effectiveness.

Methods

A comprehensive search will be undertaken of EMBASE, MEDLINE, Google Scholar, CENTRAL and Science citation index databases (1994 up to August 2017) to identify studies relevant for the review. Primary human studies evaluating clinical outcomes and cost of DIEP and implant-based reconstruction in context of breast malignancy will be included. Primary outcomes will be patient satisfaction and cosmetic outcome from patient-reported outcome measures (scores from validated tools, e.g. BREAST-Q tool), complications and cost-analysis. The secondary outcomes will be duration of surgery, number of surgical revisions, length of stay, availability of procedures and total number of clinic visits.

Discussion

This will be the first systematic review and meta-analysis in available literature comparing the clinical outcomes and cost-effectiveness of DIEP and implants for breast reconstruction. This review is expected to guide worldwide clinical practice for breast reconstruction.

Systematic review registration

PROSPERO CRD42017072557.
Appendix
Available only for authorised users
Literature
1.
Ganz PA. Psychological and social aspects of breast cancer. Oncology (Williston Park). 2008;22:642–6. 650. discussion 650, 653
2.
Helms RL, O’Hea EL, Corso M. Body image issues in women with breast cancer. Psychol Health Med. 2008;13:313–25.CrossRefPubMed
3.
Fobair P, Stewart SL, Chang S, et al. Body image and sexual problems in young women with breast cancer. Psychooncology. 2006;15:579–94.CrossRefPubMed
4.
Eltahir Y, Werners LL, Dreise MM, et al. Quality-of-life outcomes between mastectomy alone and breast reconstruction: comparison of patient-reported BREAST-Q and other health-related quality-of-life measures. Plast Reconstr Surg. 2013;132:201e–9e.CrossRefPubMed
5.
Guyomard V, Leinster S, Wilkinson M. Systematic review of studies of patients’ satisfaction with breast reconstruction after mastectomy. Breast. 2007;16:547–67.CrossRefPubMed
6.
Yueh JH, Slavin SA, Adesiyun T, Nyame TT, Gautam S, Morris DJ, et al. Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. Plast Reconstr Surg. 2010;125:1585–95.CrossRefPubMed
7.
Dean C, Chetty U, Forrest AP. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet. 1983;1:459–62.CrossRefPubMed
8.
Filiberti A, Tamburini M, Murru L, et al. Psychologic effects and aesthetic results of breast reconstruction after mastectomy. Tumori. 1986;72:585–8.PubMed
9.
Rowland JH, Holland JC, Chaglassian T, Kinne D. Psychological response to breast reconstruction: expectations for and impact on postmastectomy functioning. Psychosomatics. 1993;34:241–50.CrossRefPubMed
10.
Sisco M, Du H, Warner JP, Howard MA, Winchester DP, Yao K. Have we expanded the equitable delivery of postmastectomy breast reconstruction in the new millennium? Evidence from the National Cancer Data Base. J Am Coll Surg. 2012;215:658–66. discussion 666CrossRefPubMed
11.
Lagares-Borrego A, Gacto-Sanchez P, Infante-Cossio P, Barrera-Pulido F, Sicilia-Castro D, Gomez-Cia TA. Comparison of long-term cost and clinical outcomes between the two-stage sequence expander/prosthesis and autologous deep inferior epigastric flap methods for breast reconstruction in a public hospital. J Plast Reconstr Aesthet Surg. 2016;69:196–205.CrossRefPubMed
12.
Fischer J, Nelson J, Cleveland E. Breast reconstruction modality outcome study: a comparison of expander/implants and free flaps in select patients. Plast Reconstr Surg. 2013;131:928–34.CrossRefPubMed
13.
Liu C, Momeni A, Zhuang Y, et al. Outcome analysis of expander/implant versus microsurgical abdominal flap breast reconstruction: a critical study of 254 cases. Ann Surg Oncol. 2014;21:2074–82.CrossRefPubMed
14.
Pirro O, Mestak O, Vindigni V, Sukop A, Hromadkova V, Nguyenova A, et al. Comparison of patient-reported outcomes after implant versus autologous tissue breast reconstruction using the BREAST-Q. Plast Reconstr Surg Glob Open. 2017;5:e1217.CrossRefPubMedPubMedCentral
15.
Spear S, Newman M, Bedford S, et al. A retrospective analysis of outcomes using three common methods for immediate breast reconstruction. Plast Reconstr Surg. 2008;122:340–7.CrossRefPubMed
16.
Alderman A, Wilkins E, Lowery J, et al. Determinants of patient satisfaction in postmastectomy breast reconstruction. Plast Reconstr Surg. 2000;106:769–76.CrossRefPubMed
17.
Tønseth K, Hokland B, Tindholdt T, et al. Quality of life, patient satisfaction and cosmetic outcome after breast reconstruction using DIEP flap or expandable breast implant. J Plast Reconstr Aesthet Surg. 2008;61:1188–94. Epub 2007 Jul 2CrossRefPubMed
18.
Grover R, Padula WV, Van Vliet M, Ridgway EB. Comparing five alternative methods of breast reconstruction surgery: a cost-effectiveness analysis. Plast Reconstr Surg. 2013;132:709e–23e.CrossRefPubMed
19.
Atherton DD, Hills AJ, Moradi P, Muirhead N, Wood SH. The economic viability of breast reconstruction in the UK: comparison of a single surgeon’s experience of implant; LD; TRAM and DIEP based reconstructions in 274 patients. J Plast Reconstr Aesthet Surg. 2011;64:710–5.CrossRefPubMed
20.
Agha RA, Fowler AJ, Herlin C, Goodacre TE, Orgill DP. Use of autologous fat grafting for breast reconstruction: a systematic review with meta-analysis of oncological outcomes. J Plast Reconstr Aesthet Surg. 2015;68:143–61.CrossRefPubMed
21.
Steiert AE, Boyce M, Sorg H. Capsular contracture by silicone breast implants: possible causes, biocompatibility, and prophylactic strategies. Med Devices (Auckl). 2013;6:211–8.
22.
Spear SL, Murphy DK. Allergan silicone breast implant U.S. Core clinical study group. Natrelle round silicone breast implants: Core study results at 10 years. Plast Reconstr Surg. 2014;133:1354–61.CrossRefPubMedPubMedCentral
23.
Bajaj AK, Chevray PM, Chang DW. Comparison of donor-site complications and functional outcomes in free muscle-sparing TRAM flap and free DIEP flap breast reconstruction. Plast Reconstr Surg. 2006;117:737–46. discussion 747CrossRefPubMed
24.
Matros E, Albornoz CR, Razdan SN, Mehrara BJ, Macadam SA, Ro T, et al. Cost-effectiveness analysis of implants versus autologous perforator flaps using the BREAST-Q. Plast Reconstr Surg. 2015;135:937–46.CrossRefPubMed
25.
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA. Preferred reporting items for systematic review and metaanalysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1–9.CrossRefPubMedPubMedCentral
26.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.CrossRefPubMed
27.
Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.CrossRefPubMedPubMedCentral
28.
Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.CrossRefPubMedPubMedCentral
29.
Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan) version 5.2; 2012
30.
31.
Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ 2004;328: 1490
Metadata
Title
Protocol for a systematic review and meta-analysis on the clinical outcomes and cost of deep inferior epigastric perforator (DIEP) flap versus implants for breast reconstruction
Authors
Ankur Khajuria
Oliver J. Smith
Maxim Prokopenko
Maximillian Greenfield
Afshin Mosahebi
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Systematic Reviews / Issue 1/2017
Electronic ISSN: 2046-4053
DOI
https://doi.org/10.1186/s13643-017-0628-y

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