SIEA Flap Procedure for Breast Reconstruction

SIEA Flap Breast Reconstruction

A Natural, Muscle-Preserving Approach

The Superficial Inferior Epigastric Artery (SIEA) Flap is a type of perforator flap that uses skin and fat from the lower abdomen to recreate a breast lost to mastectomy—without sacrificing muscle. Like the DIEP flap, the SIEA flap typically offers a tummy-tuck-like benefit to your abdominal contour, while minimizing postoperative discomfort and preserving abdominal strength. Although theoretically an SIEA flap has the advantage of not even requiring dissection of blood vessels through muscle, the superficial blood vessels are frequently not robust enough to reliably carry the tissue needed for breast restoration.

What is the SIEA Flap?

(A) The superficial inferior epigastric artery (SIEA) and vein (SIEV) provide blood flow to the skin and fat used for this flap. These vessels lie just beneath the skin and do not pass through the rectus abdominis muscle. In a small percentage of women, these vessels are large enough to support the tissue required for breast reconstruction. The determination of whether to perform an SIEA flap or a DIEP flap is typically made in the operating room by your surgeon after they assess the suitability of the SIEA vessels.

(B) After the flap is transferred to the chest, the SIEA and SIEV are carefully connected (using microsurgical techniques) to blood vessels at the mastectomy site, restoring blood flow to the newly reconstructed breast.

(C) The resulting horizontal abdominal scar is similar to that of a tummy-tuck, and the scar on the breast will depend on the original mastectomy approach.

(A) SIEA Flap uses lower abdominal skin and fat without involving the abdominal muscles.

Muscle Preservation & Perforator Flaps

Perforator flaps—such as the SIEA flap and the well-known DIEP flap—avoid removing muscle altogether. This contrasts with musculocutaneous flaps (e.g., a free TRAM flap), that do take part of the rectus abdominis muscle away from the abdomen. Because muscle does not regenerate, preserving this muscle in the abdomen is key for maintaining core strength, preventing hernias, and reducing postoperative pain.

How Does SIEA Compare to DIEP?

From a patient’s perspective, the SIEA and DIEP flaps appear and feel quite similar:

Both use lower abdominal skin and fat.
Both require microsurgical connection of blood vessels to restore circulation.
Both can enhance abdominal contour in a way akin to a tummy-tuck.
Both flaps are done without destroying or removing abdominal muscle.

However, the SIEA flap is only possible if the superficial vessels are large enough to sustain the needed tissue—this occurs in a very small percentage of women.

Abdominal Contouring

Like a tummy-tuck, the SIEA flap procedure removes excess skin and fat from the lower abdomen, often enhancing abdominal contour. Since the incision typically spans the lower abdomen, most women can easily conceal it under clothing and swimwear.

Optimizing Aesthetics: Stage II Procedures

Around three months after the initial SIEA flap surgery, you may opt for additional outpatient procedures—collectively known as Stage II—to:

Reconstruct nipples if they were removed during mastectomy.
Refine the shape of your reconstructed breast.
Improve symmetry with your untreated breast.

These procedures help you achieve a personalized result that aligns with your cosmetic goals.

Frequently Asked Questions

Who is a good candidate for an SIEA flap?
Every patient who has sufficient tissue on their lower abdomen to reconstruct one or both breasts may be a candidate for an SIEA flap. Whether or not an SIEA or DIEP flap is the best option will depend on each individual’s blood vessel anatomy.

How long is the hospital stay?
Perforator flap reconstruction with an SIEA flap typically requires a 2 night stay in the hospital to minitor blood flow after surgery.

Will I have much discomfort in my abdomen?
Because perforator flap surgery does not cause significant muscle spasm, pain is not generally an issue after these procedures. Most patients can recover without the need for much if any narcotic medication.

Can I expect a ‘tummy-tuck’ effect?
Absolutely!

Explore All Perforator Flap Options

Not sure if the SIEA flap is the right choice for you? Our practice offers a variety of perforator flap procedures and other reconstructive techniques to address different needs and body types.

View All Perforator Flap Procedures

We Are Here to Help

If you’re considering SIEA Flap Breast Reconstruction, our specialized microsurgical team at TPRSG is here to assist you every step of the way. Contact us today to schedule a consultation and learn how this muscle-preserving option might fit your reconstructive goals.

SIEA Flap