SIEA (superficial inferior epigastric artery) Flap

The abdominal perforator flap for breast reconstruction, developed in 1992 by Dr. Robert Allen, is a technique that uses the same abdominal skin and fat as what is removed during an abdominoplasty (tummy tuck) procedure to create a breast. The abdominal skin, fat, and the blood vessels that nourish the abdominal tissue are used to create a breast.

In contrast to a TRAM flap, the rectus abdominis muscle and the function of the muscle are maintained with perforator flap surgery. The advantages of preserving the rectus abdominis muscle in the abdomen are maintaining core abdominal strength and reducing complications of the abdomen, such as hernias. In addition, we have noticed a great decrease in postoperative pain when the muscle is not cut.

The abdominal perforator flaps are named after the artery used to nourish the abdominal tissue. The abdominal flap is called a DIEP flap, when the deep inferior epigastric artery peforator is used or a SIEA flap, when the superficial inferior epigastric artery is used. With a SIEA flap breast reconstruction, the abdominal skin and fat and small blood vessels that nourish this tissue are transferred to the chest to create a breast. The superfical inferior epigastic artery and vein are connected to blood vessels in the chest under a microscope. The rectus abdominis muscle and the function of the muscle are maintained with this procedure.

The advantage of using the SIEA vessels are that the anterior rectus sheath fascia (tough tissue covering the muscle) is not cut and the muscle fibers are not spread and dissected). The disadvantage of using the SIEA vessels are that the caliber is much smaller than the DIEP vessels in the great majority of patients, the amount of tissue nourished by the SIEA vessels is usually less, and the patency rate (blood continuing to flow through the vessels) is less. 

Dr. Vasile is able to identify the best blood vessel branch to use by imaging the vessels ahead of time with magnetic resonance angiography (MRA). This enables Dr. Vasile to plan the surgery in advance, which can reduce operative and general anesthesia time. In addition, the location and caliber of the best vessels are confirmed on MRA to identify suitable patients and donor sites for the surgery. This results in improved flap design and planning.

Content Copyright, Dr. Julie Vasile