Extended Reality Technologies for Visualization in DIEP Flap Breast Reconstruction: A Systematic Review

Background Deep inferior epigastric artery perforator (DIEP) flap breast reconstruction is the gold standard for autologous breast reconstruction but is complex due to variable vascular anatomy. Traditional imaging modalities like computed tomography angiography (CTA) provide two-dimensional visualization, which can limit spatial understanding. Extended reality (XR) technologies, including virtual reality (VR), augmented reality (AR), and mixed reality (MR) offer immersive three-dimensional visualization that may enhance surgical planning and intraoperative guidance. This systematic review synthesizes current evidence regarding XR applications in DIEP flap breast reconstruction.Methods A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Embase, and Scopus were searched for original research articles reporting clinical use of XR technologies in DIEP flap breast reconstruction. Data on study characteristics, XR technologies used, outcomes, and key findings were extracted and analyzed.Results Thirteen studies involving 265 patients met inclusion criteria. Seven studies utilized AR, six used VR, and none focused on MR. XR technologies were associated with improved accuracy in perforator identification, reduced operating times, and enhanced surgical planning. Identified limitations included soft tissue deformation affecting intraoperative application, ergonomic issues with headsets, and technological constraints such as processing power and network.Conclusion XR technologies show significant potential in improving preoperative planning and intraoperative guidance in DIEP flap breast reconstruction. While preliminary results are promising, further large-scale studies are needed to establish efficacy, address limitations, and facilitate integration into clinical practice.