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ST. LOUIS BREAST RECONSTRUCTION: SUPERFICIAL INFERIOR EPIGASTRIC ARTERY (SIEA) FLAP

What is a SIEA flap? The SIEA flap uses the abdominal skin and fat to rebuild the breast. Either one or both breasts can be reconstructed with a SIEA flap. In appropriate candidates, it provides the best functional outcomes of any reconstruction that uses the patient’s own abdominal tissues for reconstruction. Like the DIEP flap, the muscles are totally spared. The difference compared to the DIEP flap is that with the DIEP flap, the connective tissues and muscles of the abdominal wall are still cut with a DIEP flap – but not removed. With the SIEA flap, the abdominal wall muscles and fascia are not even cut. This leads to the quickest recovery times and less weakness of the abdominal wall. The abdominal tissue may provide enough tissue to build a breast without using a breast implant. SIEA flaps can be performed at the time of mastectomy (immediate reconstruction), or later on (delayed reconstruction).

The SIEA flap is a highly technical operation that involves a technique called microsurgery. This means that the abdominal tissues are transferred to the breast area and their blood vessels reconnected under a microscope to maintain blood flow. Surgeons, operating room teams and hospitals that have significant experience with microsurgery perform the SIEA flap. Not all patients are candidates for SIEA flaps because not everyone has adequate SIEA blood vessels to perform the operation.

Not all patients are candidates for a SIEA flap, but several other microsurgical and other flap options may still be available. If a SIEA flap is not possible, other excellent alternatives include the DIEP flap or a muscle-sparing free TRAM flap, which can be performed by taking minimal muscle and still requires microsurgery. Another microsurgical option is the transverse upper gracilis (TUG) flap, which uses tissue from the inner thigh to rebuild the breast. Pedicled TRAM or latissimus flaps are also excellent options for breast reconstruction in select patients when microvascular surgery is not a favored option.

Reconstructive timeline with SIEA flap:

• First operation: Breast reconstruction with SIEA flap(s) ± mastectomy.
• Office visits: Drain removals and wound checks.
• 3 months*: “Touch up” cosmetic appearance of SIEA flap if required; possible balancing procedure on other side. Possible fat grafts to optimize breast contours.
• 6 months*: Nipple reconstruction. Possible fat grafts to optimize breast contours.
• 8 months*: Areola (pigmented circle that surrounds the nipple) reconstruction with tattoo.
• 12 -24 months*: Laser or IPL scar therapy

* If you are having an immediate SIEA flap (mastectomy and SIEA flap at the same time) and chemotherapy is required, please add 4 months to the timeline. If radiation therapy is also required, please add 9 months to the timeline.  

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Anesthesia: A SIEA flap is performed with the patient under general anesthesia.

Length of procedure: 4 to 7 hours for one breast, 6 to 10 hours for two breasts.

Estimated recovery time: Hospitalization is usually 3 to 5 days. You can return to work after 3 to 6 weeks, depending on your job, and you should avoid vigorous activities for 6 weeks. Visible bruising and swelling should begin to improve within 3 weeks. Recovery time, however, is highly variable and depends on your health before surgery and history of smoking and radiation therapy. Unless you have an allergy, you will be required to take aspirin for one year after surgery. To learn how to prepare for a SIEA flap breast reconstruction and what to expect afterwards, click here to download our patient instructions for SIEA, DIEP flap and free microvascular TRAM flap breast reconstruction.

Side effects: Common side effects include bruising and swelling. Blood flow to your flap will be carefully monitored after surgery. If there are concerns about the flap, you may require reoperation to assess the blood flow. Delayed wound healing and infections may occur. Click here to download a detailed consent form from the American Society of Plastic Surgeons that lists the risks and benefits of a DIEP flap breast reconstruction, which are similar to those for an SIEA flap.

Before-and-after photos of breast reconstructions with SIEA, DIEP and TRAM flaps: Click here