The gold standard for breast reconstruction in our unit are the DIEP flap and the S-GAP flap, the latter especially in cases with insufficient abdominal excess, more specific bilateral breast reconstruction in thin patients, Between January 1998 and October 2002, 300 breasts were reconstructed of which 256 were DIEP flaps, 33 S-GAP flaps and 11 SIEA flaps. The first SIEA flap in our unit was performed in July 2001. In a period of 14 months, 11 breasts were reconstructed using the SIEA flap. An SIEA flap was harvested every time when dissection in the lower abdomen revealed a large superficial epigastric artery. The artery in the SIEA flap is the limiting factor that decides whether an SIEA flap can be harvested or not. Zone 4 was used in only 1 flap, zone 3 was used in 4 flaps and in the remaining flaps only zone 1 and 2 were used for free tissue transfer. No SIEA flaps were lost and all flaps healed without skin necrosis or clinically significant fat necrosis. The superficial inferior epigastric pedicle length averaged approximately 7 cm. The internal mammary vessels were used as recipients in 9 flaps and the internal mammary perforators in two flaps. Always the contralateral pedicle was harvested to reconstruct the breast and the flap was turned 90 degrees prior to insetting. This in order to allow easy approximation for microanastomosis and modelling of the flap at the recipient site. Conclusion: The free SIEA flap is an attractive option for autologous breast reconstruction but due to the shorter pedicle asks for careful preoperative planning. The incidence of pedicle diameter of the superficial inferior epigastric artery, sufficient enough to carry a large adipocutaneous flap, is rather small in our series. The advantage of the SIEA flap is ease of pedicle dissection and absence of injury to the underlying anterior rectus fascia.