SIEA Flap for Breast Reconstruction

Abstract

A 52-year-old woman presented to our department for delayed left breast reconstruction, following left breast mastectomy and chemo- and radiotherapy for inflammatory carcinoma almost 10 years ago. Following discussion with the patient about the reconstructive options, it was agreed to proceed with free autologous tissue from the abdominal area. CT angiography revealed bilateral dominance of the superficial systems, so the decision was made to reconstruct the breast with superficial inferior epigastric artery perforator (SIEA) flap. The flap was performed without intra- or postoperative complication, and the patient is well and happy with cosmesis over 5 years later.

This is a flap that is relatively easy to raise, the donor defect is minimal, and in this way it is advantageous to the other abdominal flaps. Some authors have also reported reduced hospital stay in relation to other abdominal free flaps.

However, it is not always anatomically feasible, and there are special technical considerations that require certain experience in the handling of the flap. The unreliable vascular territory, which varies widely, makes the use of this flap challenging, and possibly this is the reason that the earlier plastic surgeons sought different solutions, the TRAM and subsequently the DIEP flap. However, with improved preoperative and intraoperative imaging tools, this flap offers an attractive solution. Maybe in the future, minimally invasive delay techniques, which result in a wider and more reliable perfusion pattern, will improve the appeal of this elegant flap.