A Novel Stacked SIEA Flap for Unilateral Immediate Breast Reconstruction

Breast reconstruction using a perforator-based autologous flap is increasingly recognized as the preferred technique that provides an aesthetically pleasing restoration of breast form and volume with longevity. Autologous flap reconstruction is widely accepted as the gold standard with deep inferior epigastric artery perforator (DIEP) flap being favored.[1]

When there is insufficient abdominal tissue to recreate a symmetrical contralateral breast shape and volume, stacking flaps using a bipedicled technique has been shown to be an efficacious technique for achieving adequate volume.[2] Bilateral DIEP flaps are typically stacked for unilateral reconstruction. Alternatively, a single DIEP can be combined with another autologous flap, most commonly the profunda artery perforator (PAP) and superior gluteal artery perforator flaps to achieve the desired volume.[3]

Stacking superficial inferior epigastric artery (SIEA) flaps are sparsely reported in the literature. Malata et al reported a single case over of a Hamdi type1 bipedicled immediate stacked SIEA over a 40-month period with 112 consecutive flaps,[4] and Murray et al reported a single case of a delayed stacked SIEA reconstruction over a 5-year period with 18 consecutive unilateral stacked breast reconstructions.[5]

To our knowledge, this is the first reported case of stacked perforator-to-perforator SIEA flap for an immediate unilateral breast reconstruction.

• References

• 1 Nahabedian MY, Dooley W, Singh N, Manson PN. Contour abnormalities of the abdomen after breast reconstruction with abdominal flaps: the role of muscle preservation. Plast Reconstr Surg 2002; 109 (01) 91-101
• 2 Rabey NG, Erel E, Malata CM. Double-pedicled abdominal free flap using an entirely new microvascular combination of DIEP and SIEA vascular pedicles for unilateral breast reconstruction: a novel addition to the Hamdi classification. Plast Reconstr Surg 2012; 130 (05) 767e-769e
• 3 Mayo JL, Allen RJ, Sadeghi A. Four-flap breast reconstruction: bilateral stacked DIEP and PAP flaps. Plast Reconstr Surg Glob Open 2015; 3 (05) e383 . Doi: 10.1097/GOX.0000000000000353
• 4 Malata CM, Rabey NG. Decision making in double-pedicled DIEP and SIEA abdominal free flap breast reconstructions: an algorithmic approach and comprehensive classification. Front Surg 2015; 2: 49 . Doi: 10.3389/fsurg.2015.00049
• 5 Murray A, Wasiak J, Rozen WM, Ferris S, Grinsell D. Stacked abdominal flap for unilateral breast reconstruction. J Reconstr Microsurg 2015; 31 (03) 179-186
• 6 Hamdi M, Khuthaila DK, Van Landuyt K, Roche N, Monstrey S. Double-pedicle abdominal perforator free flaps for unilateral breast reconstruction: new horizons in microsurgical tissue transfer to the breast. J Plast Reconstr Aesthet Surg 2007; 60 (08) 904-912 , discussion 913–914
• 7 DellaCroce FJ, Sullivan SK, Trahan C. Stacked deep inferior epigastric perforator flap breast reconstruction: a review of 110 flaps in 55 cases over 3 years. Plast Reconstr Surg 2011; 127 (03) 1093-1099
• 8 DellaCroce FJ, Sullivan SK, Trahan C, Jenkins CE. Body lift perforator flap breast reconstruction: a review of 100 flaps in 25 cases. Plast Reconstr Surg 2012; 129 (03) 551-561
• 9 Chevray PM. Breast reconstruction with superficial inferior epigastric artery flaps: a prospective comparison with TRAM and DIEP flaps. Plast Reconstr Surg 2004; 114 (05) 1077-1083 , discussion 1084–1085
• 10 Choi M, Small K, Levovitz C, Lee C, Fadl A, Karp NS. The volumetric analysis of fat graft survival in breast reconstruction. Plast Reconstr Surg 2013; 131 (02) 185-191