Purpose: Morbidity of the abdominal wall is reduced but not eliminated with the deep inferior epigastric perforator (DIEP) flap in comparison to the TRAM flap for breast reconstruction. The superficial inferior epigastric artery free flap (SIEF) completely spares the abdominal wall, yet variable anatomy has prevented it from gaining wide popularity. Materials and Methods: A restrospective review of SIEF breast reconstructions performed from 1988-2002 was conducted to assess flap anatomy, complications, and outcome. In a separate group of ten patients, duplex ultrasound of the SIEF vasculature was performed preoperatively to assess vessel location and external diameter. The results were compared to intraoperative measurements. Results: 23 SIEF flaps were used for breast reconstruction in 18 patients. Complications included 1 total flap loss, 1 partial loss, 2 hematomas, and 6 flaps with fat necrosis. 2 cases required postoperative microvascular revision. Preoperative duplex studies correlated well with vessel presence and location but were less accurate in assessment of small vessels. Conclusion: The SIEF flap is an attractive option for breast reconstruction due to its minimal donor site morbidity. However, small vessel size and variable anatomy limits its widespread use. Preoperative duplex ultrasonography performed by trained technicians can be a useful planning tool.