INTRODUCTION: In 1989, the first superficial inferior epigastric artery (SIEA) flap for breast reconstruction was performed at Charity Hospital (New Orleans). Initially, the SIEA flap was greeted with tempered enthusiasm because the pedicle diameter and length were small. A more technically challenging microsurgical scenario was encountered compared to free TRAM/DIEP flaps. The advantages of the flap included 1) preservation of the abdominal muscle/fascia integrity similar to an abdominoplasty and 2) perfusion of ample skin and fat for breast reconstruction. These favorable characteristics of the SIEA flap made it an attractive donor flap; therefore, further evaluation and technical refinement was initiated.

MATERIALS & METHODS: A 7 year retrospective chart review was performed to evaluate SIEA flap breast reconstruction patients performed at a single institution. Patient demographics, timing of breast reconstruction, etiology of breast defect, and postoperative complications were determined.

RESULTS: From 1997 - 2004, 210 SIEA flaps were performed on 174 patients for breast reconstruction. The patients ranged from 15 to 70 years of age (mean 46 years). The internal mammary vessels were always used as recipient vessels. The arterial and venous diameter at the take off from the common femoral ranged from 1.5-2.5 and 2.0-4.0 mm, respectively. OR time averages 4 hours. The take back rate was similar to a DIEP flap (5.6%). The flap volume is limited to the hemi-abdomen but can be extended laterally. All 210 SIEA flaps survived. 43% underwent immediate reconstruction after skin-sparing mastectomy. In this study, 18 patients had bilateral reconstructions. Of these, 76% had one SIEA and one DIEP flap; 24% had bilateral SIEA flaps. Four flaps (2%) were for augmentation of the contralateral breast for symmetry. One case was breast reconstruction for Poland's Syndrome. Seromas were seen at the donor site in 4% of patients. Fat necrosis was apparent in 13%. 4% of all SIEA flap cases had donor-site wound healing problems, but eventually healed without significant sequelae. In our series, hernias or bulges were not observed after SIEA flap harvest while a low incidence (0.6%) was observed after DIEP flap harvest.

CONCLUSIONS: We report the largest experience to date on the SIEA flap for breast reconstruction. This adipocutaneous flap can be an excellent choice for breast reconstruction patients with favorable vascular anatomy. Good aesthetic results without functional donor site morbidity can be achieved.