PURPOSE: Breast reconstruction using the TRAM flap technique has evolved from the pedicled to the free TRAM, the muscle sparing free TRAM, and then the DIEP flap. Each variation in this progression has involved harvest of decreasing amounts of rectus abdominus muscle and anterior fascia with the aim of decreasing abdominal donor site weakness, discomfort, complications, and hospital stay. Breast reconstruction using the lower abdominal free superficial inferior epigastric artery (SIEA) flap has the potential to virtually eliminate abdominal donor site morbidity and complications because the rectus abdominus fascia and muscle are neither excised nor incised. Despite its advantages, the free SIEA flap for breast reconstruction is rarely used.

RESULTS: The author reports his experience with 9 free SIEA flap breast reconstructions in 7 patients. The free SIEA flap was attempted in 20 consecutive free autologous tissue breast reconstructions between August 2001 and April 2002. A free SIEA flap was not done in 11 of these 20 cases (55%) because the superficial inferior epigastric artery was absent or deemed too small. An adequate vein was present in all 20 cases. Average patient age was 46 years, and average BMI was 30. One of the nine SIEA flaps was lost due to arterial thrombosis. The remaining 8 SIEA flaps have healed without clinically significant fat necrosis. The superficial inferior epigastric vessel pedicle length averaged approximately 8 cm. The internal mammary vessels were used as recipients in all SIEA flap cases to allow positioning the flap sufficiently medially on the chest wall. Moderate and large size breasts were reconstructed with hemi lower abdominal flaps with aesthetic results equal to those obtained with TRAM and DIEP flaps. The average hospital stay was shorter for the SIEA flap patients, but this was not statistically significant in this initial small series.

CONCLUSIONS: The free SIEA flap is an attractive option for autologous tissue breast reconstruction. Harvest of this flap does not injure the anterior rectus fascia or underlying rectus abdominus muscle. This will potentially eliminate abdominal donor site complications such as bulge and hernia formation, and decrease weakness, discomfort, and hospital stay compared to TRAM and DIEP flaps. Its disadvantages are the smaller and shorter pedicle length compared to TRAM and DIEP flaps, and the absence or inadequacy of an arterial pedicle in over half of patients.