Like the DIEP flap, the superficial inferior epigastric artery (SIEA) flap uses tissue and fat from the abdomen to rebuild the breast and does not require the removal of any muscle, reducing the risk of abdominal weakness after surgery. The main difference between the two procedures is the vessels used to supply blood to the new breast. With the DIEP flap, surgeons remove deep inferior epigastric vessels that run below and within the abdominal muscle. The SIEA flap uses the superficial inferior epigastric veins and arteries found just below the skin, requiring no incision through the muscle.
SIEA flap reconstruction is performed by surgeons, operating room teams and hospitals that have significant experience with a technique called microsurgery. Surgeons use microscopes and other special tools to connect blood vessels and maintain blood flow in the tranferred tissue.
The SIEA flap is an option in patients who have adequate superficial inferior epigastric vessels for the reconstruction of small to moderate-sized breasts. In addition, patients typically are healthy, have had no or minimal previous abdominal surgery and are of normal body weight. Microvascular surgery alternatives may include the free TRAM flap, DIEP flap or TUG flap. When microsurgery is not an option, alternatives include the latissimus flap or pedicled TRAM flap.
SIEA flap reconstruction is performed under general anesthesia and requires four to six hours for one breast and six to nine hours for both. Patients are hospitalized for four to eight days and can return to work in four to six weeks.
Common side effects include bruising and swelling. Several temporary drain tubes remain in place after surgery. Surgeons monitor blood flow carefully. Return trips to the operating room may be necessary to restore blood flow. Delayed wound healing occasionally occurs. Flap failure is uncommon.