"Fat necrosis following deep inferior epigastric artery perforator flap breast reconstruction: A systematic…

ReviewJournal of plastic, reconstructive & aesthetic surgery : JPRAS· Jul 2026

"Fat necrosis following deep inferior epigastric artery perforator flap breast reconstruction: A systematic review and meta-analysis".

Karanvir S Raman, Arjin Akdag, Sara B A Morel … Joshua Vorstenbosch

Breast ReconstructionReviewClinical practiceQ1IF 1.9

Intraoperative indocyanine green imaging associated with lower fat necrosis risk after flap reconstruction

"Fat necrosis following deep inferior epigastric artery perforator flap breast reconstruction: A systematic review and meta-analysis".

Karanvir S Raman … Joshua Vorstenbosch

Journal of plastic, reconstructive & aesthetic surgery · Jul 2026 · Q1 in Surgery

Purpose

This study aims to identify factors predictive of postoperative fat necrosis in reconstructed breast flaps.

Methods

Following PRISMA 2020 guidelines, MEDLINE/EMBASE/CINAHL/CENTRAL databases were searched through December 4, 2024, for studies reporting the incidence of postoperative fat necrosis in DIEP flaps.

n = 100 studies

Results

Indocyanine green imaging lowered fat necrosis risk

RR by subgroup · 95% CI

More results

The systematic review (systematic review) included 100 studies (42 eligible for meta-analyzes), representing 9704 flaps.

Fat necrosis risk increased with unilateral versus bilateral reconstructions (RR 1.53, 95% CI 1.13-2.06, P=0.006) and BMI ≥25 (RR 1.60, 95% CI 1.05-2.43, P=0.03).

More results

Preoperative CT angiogram was not significantly associated with fat necrosis (RR 0.60, 95% CI 0.33-1.11, P=0.10).

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Conclusion · 1 of 2

To minimize fat necrosis, surgeons should optimize perforator selection, use intraoperative indocyanine green perfusion mapping, and augment venous outflow with Superficial Inferior Epigastric Vein anastomosis.

Conclusion · 2 of 2

Patients with elevated BMI or unilateral reconstructions should be counseled regarding their increased risk.

"Fat necrosis following deep inferior epigastric artery perforator flap breast reconstruction: A systematic review and meta-analysis".

"Fat necrosis following deep inferior epigastric artery perforator flap breast reconstruction: A systematic review and meta-analysis".

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