SIEA MICROSURGICAL BREAST RECONSTRUCTION

PaintingThe SIEA microsurgical breast reconstruction, like the DIEP reconstruction, uses dispensable abdominal tissue and has become more popular with microsurgeons in the past few years.  The SIEA reconstruction was invented many years ago, but it was felt to be too technically demanding and it did not develop a wide following among microsurgeons. But advances in microsurgery have made this flap more popular with microsurgeons.

The SIEA flap uses abdominal skin and fat to reconstruct a breast. This same tissue is discarded in patients that undergo cosmetic surgery for a 'tummy tuck'. Although the abdominal tissue used is the same as the DIEP, the SIEA relies on a distinctive blood supply and requires less surgical dissection than the DIEP.  No dissection of the muscle and fascia are required, and the flap can be prepared more easily than the DIEP flap in many respects. Whether the SIEA flap or DIEP flap can be used for reconstruction depends on intraoperative findings related to vessel size and blood flow. The decision between DIEP or SIEA is usually an intraoperative decision based on blood supply.

ABDOMINAL SKIN AND FAT

Not all patients have the SIEA blood vessels or adequate vessel size. The absence, presence or adequacy of vessels cannot be determined for certainly until after surgery begins, although a non-invasive Doppler exam can be helpful in predicting vessel presence. Patients who have had Cesarean sections are less likely to have SIEA vessels. If SIEA vessels are not present, patients are reconstructed with the DIEP flap. Although we like to perform the SIEA reconstruction if we can, since it provides an opportunity for less surgical dissection, the DIEP flap is excellent as well. Rather than calling it a second choice, we like to think of it as an equally good alternate to the SIEA.

Abdominal Tissue

Another point to remember is that if a patient requires a particularly large reconstruction that requires more than half of the abdominal skin and fat, then she may not be able to have an SIEA flap even if vessels are present. This is because the SIEA flap sometimes does not provide adequate circulation across the midline of the abdomen. If that is the case, the DIEP flap is used.

The figure above the same abdominal tissue (outlined in blue) that is used in the DIEP flap is used in the SIEA reconstruction. After this tissue is used for the reconstruction, the abdominal procedure is completed with a tummy tuck.

Advantages of the SIEA flap include:

  • Preservation of the rectus sheath with no violation of the rectus sheath

  • Preservation of the rectus muscle with no violation of the rectus muscle

  • Less post-operative pain

  • Speedier recovery

  • Shorter surgical procedure than the DIEP flap

The SIEA flap can be used for immediate or delayed breast reconstruction.

DETAILS.