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SIEA Flap Breast Reconstruction

Plastic Surgery to Restore Breast Symmetry

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Updated April 27, 2012

You have several surgical options to consider for breast reconstruction -- SIEA flap is one of many. SIEA is very similar to the DIEP flap method, but uses tissue from your lower, instead of your upper, abdomen. A SIEA reconstruction doesn't work for everyone, but there are many advantages to this procedure.

What is SIEA Flap Reconstruction?

The Superficial Inferior Epigastric Artery (SIEA) is a tissue flap procedure that uses fat, skin and blood vessels from your lower tummy to create a new breast mound after a mastectomy. This procedure is named for the superficial inferior epigastric artery in your lower tummy area and is a form of autologous breast reconstruction, a surgery that uses your own tissue.

Your reconstructed breast won't be just like your natural breast, though, and if you want a new nipple and areola, you will need to have additional reconstructive surgery.

SIEA and DIEP Flap Methods

Both the SIEA and Deep Inferior Epigastric Perforator (DIEP) flap reconstruction techniques use tissue taken from your tummy to create a new breast. Each method includes skin, fat and an artery and vein attached to your tissue flap so that it can be supplied with blood when it is transplanted to your chest. No abdominal muscle will be cut or moved during either process. Here's how these methods differ: A DIEP flap uses tissue from your upper abdomen, but the SIEA uses tissue from your lower abdomen and takes a slightly smaller section of skin and fat. Also, the SIEA blood vessels are not located within muscle, so your abdominal muscles never have to be disturbed during this procedure.

When Tummy Fat Isn't Enough

Most women do have enough extra fat and skin in their tummy area to create a new breast. If you don't have quite enough, a small implant may be positioned beneath your tissue flap to create the breast size that you want. The removal of skin and fat from your tummy results in a tummy tuck (abdominoplasty), so your abdominal area will be flatter after your incision heals.

Advantages and Disadvantages of SIEA Reconstruction

Pros:
  • No muscle is moved (unlike a TRAM or Lat flap).
  • There is very little risk of developing an abdominal hernia as a result of this procedure.
  • There is less pain, quicker recovery than a TRAM flap.
  • Removal of tummy skin and fat results in a flatter belly
  • SIEA flap procedure has a less than 1% failure rate.
Cons:
  • SIEA takes more time in surgery than a TRAM flap.
  • Since you will have two surgical sites, two scars result.
  • If a SIEA reconstruction fails, the tissue flap may die and will have to be completely removed.
  • If the flap fails, new reconstruction may not be done for 6 to 12 months.

You're Not a Good Candidate for the SIEA Flap If:

  • there is not enough tummy fat -- you have already had abdominal skin and fat removed
  • you are very thin -- you don't have ample skin and fat on your belly
  • you are an active smoker -- your abdominal scar will heal slowly, and your fat tissue is more likely to turn into scar tissue.

Should Your Breast Reconstruction Be Immediate or Delayed?

Breast reconstruction can be done during a mastectomy or after chemo and radiation, for breast cancer. If you need radiation treatments aimed at your underarm area or chest, it would be wise to have delayed reconstruction, because having the procedure done after radiation gives your radiation therapist more range to properly treat your cancer.

Good Reasons to Consult a Plastic Surgeon Before a Mastectomy

If you are seriously considering reconstruction, it's a good idea go see your plastic surgeon before having a mastectomy. This gives you the chance to have precise measurements and pictures taken of your natural breasts. A plastic surgeon will use this information to make your reconstructed breast as close to natural shape and size as possible. You can ask to see photos of completed reconstructions to help you make a decision. If you consult with a plastic surgeon beforehand, they will give you a range of choices, help you save breast skin and prevent unnecessary scars.

What to Expect During a SIEA Breast Reconstruction

You will have intravenous sedation or general anesthesia during your mastectomy or SIEA reconstruction, so you will not be awake. If you've ever had surgery and experienced nausea and vomiting because of the anesthesia, ask if you can be pretreated. If you are having immediate reconstruction (mastectomy and reconstruction at the same time), your general surgeon will remove your breast first, sparing as much skin as possible.

Getting Ready for SIEA Breast Reconstruction

SIEA Flap Breast Reconstruction
Illustration © Pam Stephan
Using a skin marker, your plastic surgeon will draw a semi-elliptical section across your lower tummy, between your navel and your pubic area. This semi-ellipse becomes the skin flap that closes the incision for your new breast. When your abdominal incision flap is shut, it becomes a line that goes across your tummy.

Moving Fat, Skin and Blood Vessels

SIEA Flap Breast Reconstruction
Illustration © Pam Stephan
Your surgeon starts by making an incision along the marked skin on your lower tummy and raising a layer of skin and fat. Before disconnecting this tissue flap, he will search for the superficial inferior epigastric artery and vein that will provide a dependable blood supply to your new breast. No muscle has to be moved or cut to get to these particular blood vessels. Your tummy incision will be closed, and drains may be placed to prevent fluid build-up and promote healing. Your navel will not be moved or stretched.
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