Breast Reconstruction with SIEA Flaps: A Single-Institution Experience with 145 Free Flaps

Area of Science:

• Microsurgery
• Plastic Surgery
• Reconstructive Surgery

Background:

• Superficial inferior epigastric artery (SIEA) and superficial circumflex iliac artery (SCIA) flaps have undergone refinements for breast reconstruction.
• Technical challenges and variable success rates have limited the widespread adoption of SIEA/SCIA flaps.

Purpose of the Study:

• To present the outcomes of 145 consecutive SIEA/SCIA flaps.
• To offer technical recommendations for improving the success rate of SIEA/SCIA flaps in breast reconstruction.

Main Methods:

• Retrospective chart review of SIEA/SCIA free flaps performed between January 1, 2006, and February 6, 2014.
• Data collection included patient demographics, flap characteristics, and complication rates.

Main Results:

• 145 flaps were performed in 119 patients, with arterial mismatch in 38%.
• Arterial revisions were performed in 80% of cases, and the total flap loss rate due to thrombosis was 4.8%.
• No abdominal bulges or hernias were reported; fat necrosis occurred in 10.3% of flaps.

Conclusions:

• SIEA/SCIA breast reconstruction is a reliable procedure.
• Postoperative arterial thrombosis with initial revision surgery indicates a low likelihood of salvage.
• Donor artery manipulation is recommended to address size discrepancies, and spatulation does not increase thrombosis risk.