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
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Published version
Author(s)
Khajuria, AK
Smith, OJS
Prokopenko, MP
Greenfield, MG
Mosahebi, AM
Type
Journal Article
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 synthesize 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; 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
Key words: Breast implant; DIEP; cost-effectiveness; autologous flap reconstruction; deep inferior epigastric artery perforator flap
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 synthesize 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; 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
Key words: Breast implant; DIEP; cost-effectiveness; autologous flap reconstruction; deep inferior epigastric artery perforator flap
Date Issued
2017-11-22
Date Acceptance
2017-11-16
Citation
Systematic Reviews, 2017, 6
ISSN
2046-4053
Publisher
BioMed Central
Journal / Book Title
Systematic Reviews
Volume
6
Copyright Statement
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
License URL
Subjects
Deep inferior epigastric artery perforator flap
Autologous flap reconstruction;
Breast implant
DIEP
Cost-effectiveness
Publication Status
Published
Article Number
232
Date Publish Online
2017-11-16