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Background <p>Autologous breast reconstruction aims to restore form and well-being after mastectomy, with increasing emphasis on long-term functional outcomes and quality of life. Perforator flaps (e.g., DIEP, TAP) preserve muscle, potentially reducing donor-site morbidity, while musculocutaneous flaps (e.g., TRAM, latissimus dorsi) involve muscle sacrifice, which may impair function.&#xa0;We aimed to systematically compare long-term functional outcomes and quality of life between perforator and musculocutaneous flaps in postmastectomy breast reconstruction.</p> Methods <p>Randomized controlled trials (RCTs) comparing perforator versus musculocutaneous flaps or tissue expanders were included if they reported validated functional or quality-of-life outcomes with ≥ 12 months of follow-up. Searches were conducted in MEDLINE, Embase, and LILACS. Study selection and data extraction were performed independently in duplicate. Risk of bias was assessed using the Cochrane tool. A structured narrative synthesis was conducted.</p> Results <p>Seven RCTs evaluated DIEP, TAP, LD, and other flap techniques. Perforator flaps were associated with modest improvements in breast satisfaction and sexual well-being (e.g., DIEP vs. TE: BREAST-Q 72.1 vs. 63.4; <i>p</i> = 0.03) and better shoulder function in TAP versus LD (CSS 80.1 vs. 76.3; <i>p</i> = 0.033). However, complication rates were higher with DIEP (e.g., 31% vs. 4% in irradiated patients; <i>p</i> = 0.026), and no consistent differences were observed in overall quality of life or objective function. Evidence was limited by small sample sizes, risk of bias, and heterogeneity across studies.</p> Conclusions <p>Perforator flaps may offer small subjective benefits without demonstrating consistent functional or quality-of-life superiority over musculocutaneous flaps. Given the low certainty due to methodological limitations, surgical decisions should be individualized. Further high-quality RCTs with long-term follow-up, subgroup analyses, and complete reporting of confidence intervals and effect sizes are needed to inform patient-centered care in breast reconstruction.&#xa0;</p> <p>Level of Evidence: Level I, risk / prognostic study.</p>

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Perforator vs. musculocutaneous flaps in breast reconstruction: a systematic review on differences in long-term functional outcomes and quality of life

  • 期刊论文

  • 发表日期：

    2026年2月14日

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  • Francisco Javier Gómez Ballesta,
  • Juan Sebastián Barrera Sánchez,
  • Miguel Francisco Amaris Bracamonte,
  • Camila Alejandra Rodríguez Cadena,
  • Daniela Dávila Vargas,
  • Juan Pablo Alzate Granados

摘要

Background

Autologous breast reconstruction aims to restore form and well-being after mastectomy, with increasing emphasis on long-term functional outcomes and quality of life. Perforator flaps (e.g., DIEP, TAP) preserve muscle, potentially reducing donor-site morbidity, while musculocutaneous flaps (e.g., TRAM, latissimus dorsi) involve muscle sacrifice, which may impair function. We aimed to systematically compare long-term functional outcomes and quality of life between perforator and musculocutaneous flaps in postmastectomy breast reconstruction.

Methods

Randomized controlled trials (RCTs) comparing perforator versus musculocutaneous flaps or tissue expanders were included if they reported validated functional or quality-of-life outcomes with ≥ 12 months of follow-up. Searches were conducted in MEDLINE, Embase, and LILACS. Study selection and data extraction were performed independently in duplicate. Risk of bias was assessed using the Cochrane tool. A structured narrative synthesis was conducted.

Results

Seven RCTs evaluated DIEP, TAP, LD, and other flap techniques. Perforator flaps were associated with modest improvements in breast satisfaction and sexual well-being (e.g., DIEP vs. TE: BREAST-Q 72.1 vs. 63.4; p = 0.03) and better shoulder function in TAP versus LD (CSS 80.1 vs. 76.3; p = 0.033). However, complication rates were higher with DIEP (e.g., 31% vs. 4% in irradiated patients; p = 0.026), and no consistent differences were observed in overall quality of life or objective function. Evidence was limited by small sample sizes, risk of bias, and heterogeneity across studies.

Conclusions

Perforator flaps may offer small subjective benefits without demonstrating consistent functional or quality-of-life superiority over musculocutaneous flaps. Given the low certainty due to methodological limitations, surgical decisions should be individualized. Further high-quality RCTs with long-term follow-up, subgroup analyses, and complete reporting of confidence intervals and effect sizes are needed to inform patient-centered care in breast reconstruction. 

Level of Evidence: Level I, risk / prognostic study.