SIEA Flap for Breast Reconstruction: Results, Complications and Comparison with the DIEP Flap

The use of autologous tissue for beast reconstruction is an attractive option for both surgeons and patients. After the rising interest in the deep inferior epigastric perforator (DIEP) flap during the last decade, some surgeons reported the use of a previously described flap based on the superficial inferior epigastric artery (SIEA). From November 2001 to June 2004, 43 breast reconstructions with an SIEA flap were performed at the authors' institution.

The mean operative time was 4.8 hr and this was significantly more rapid than the operative time for a DIEP flap (p< 0.05). The SIEA flap was performed when the internal diameter at the origin of the superficial inferior epigastric artery was 1.4 mm, as assessed with preoperative ultrasound. There were two total flap losses due to arterial insufficiency and one partial flap loss. Fat necrosis occurred in four cases, but only two of them needed surgical correction. No significant differences were seen compared to breast complications in 236 DIEP flaps performed in the same period. Abdominal complications included five seroma, one hematoma, and two patients had impaired wound healing of the abdominoplasty wound. Again, no significant differences were observed compared to DIEP flaps.

Smoking at operation (p = 0.02) and the inner diameter of the SIEA at its origin (p = 0.024) were significant risk factors for the development of breast complications in the patients who had SIEA flap surgery. Body Mass Index and age over 50 did not influence breast complication rate.

The authors believe the SIEA is a reliable flap, with very little donor site morbidity. It has become their first option for autologous breast reconstruction.