32 - Autologous breast reconstruction with the superficial inferior epigastric artery (SIEA) flap

Abstract

The superficial inferior epigastric artery (SIEA) flap is very attractive for breast reconstruction because it minimizes abdominal donor site morbidity compared with free transverse rectus abdominis musculocutaneous flap (TRAM) and deep inferior epigastric perforator (DIEP) flaps. The primary reason is because the anterior rectus fascia and rectus abdominis muscle are neither incised nor excised. At the same time, like the free TRAM and DIEP flaps, the SIEA flap provides the same flap of supple, and often abundant, skin and subcutaneous tissue from an easily accessible donor site that mimics a cosmetic abdominoplasty. The tradeoff for minimized abdominal donor site morbidity is a manyfold increased risk for flap loss compared with free TRAM and DIEP flaps, and the inconsistency of the arterial pedicle. Increased flap loss rates are due to the small diameter of the SIEA leading to size mismatch with the recipient internal mammary artery, and an inherent propensity for the SIEA to spasm. The SIEA is present and adequate for an SIEA flap in approximately 30% of patients. The gain in abdominal donor site morbidity must be weighed against the increased risk of emergent reoperation and flap loss.