Superficial Inferior Epigastric Artery Flap for Breast Reconstruction: Results and Complications in 43 Cases

The most physiologic method of reconstructing a breast is by means of autologous tissue. During the past decade, the authors have had a wide experience with the deep inferior epigastric artery perforator (DIEP) flap. The superficial epigastric artery flap (SIEA) avoids muscle dissection, thus lowering donor-site morbidity. Questions still remain about its reliability.

The authors presented the results and complications of their series of SIEA flaps by means of a retrospective review. In the period between July, 2001 and June, 2004, 43 SIEA flaps were performed. Follow-up ranged from 1 to 32 months. In the same period, 236 DIEP flaps were performed. Immediate reconstruction was done in 54% of the cases. One patient underwent a bilateral reconstruction with bilateral SIEA flaps.

The authors compared SIEA and DIEP flaps according to the following parameters: total/partial flap loss, revision, fat/skin necrosis, impaired abdominal wound healing, hematoma, seroma, postoperative abdominal drainage, operating time, and flap dissection time. No differences in flap loss, total or partial, were observed. No significantly higher fat necrosis rate was seen (p < 1). In the 43 SIEA flaps, 10% developed necrosis of the mastectomy skin flaps (p < 0.01). As far as donor-site morbidity, no significantly higher hematoma or impaired wound healing rate occurred. The SIEA flaps also demonstrated a better postoperative drainage (p = 0.0846), and significantly lowered the operating time by more than 1.5 hr. However, a tendency toward more seroma formation was seen (p < 0.1) with the SIEA flaps.

The SIEA flap is reliable for breast reconstruction, with no higher rate of complication. However, questions still remain about increased donor-site morbidity due to possibly higher seroma rates. Careful dissection of the SIEA vessels and multiple clipping of the lymph vessels may be a corrective to this tendency.