Advantage of SIEA vs. DIEP?


Question from Swall: What is the advantage of SIEA vs. DIEP?
Answers - Maurice Nahabedian The SIEA is an acronym that stands for superficial inferior epigastric artery flap. This is a flap that utilizes skin and fat from the abdominal area. The DIEP is an acronym that stands for deep inferior epigastric artery perforator flap. This flap also utilizes skin and fat from the abdominal area.

The difference between the two is that the DIEP flap requires a small incision to be made in the supportive layer of the abdomen as well as the rectus abdominis muscle. (That is the muscle that allows you to perform sit-ups). It runs from the rib cage down towards the pelvic bone. The SIEA flap does not require that these additional incisions be made. Both flaps have the advantage that no muscle is removed.
Marisa Weiss, M.D. Do you perform both of these procedures, and if so, which one do you prefer?
Maurice Nahabedian I perform the DIEP flap. I do not perform the SIEA flap. The SIEA flap can only be performed in about 20 to 30% of patients because the blood supply to this flap is extremely variable and poorly developed in the majority of women.
Marisa Weiss, M.D. How does DIEP compare to the TRAM flap?
Maurice Nahabedian TRAM is also an acronym that stands for transverse rectus abdominis muscle flap. This was the original flap that was described in 1982. This flap is capable of forming a very nicely shaped breast. However, it has the disadvantage of utilizing the entire rectus abdominis muscle on one side. In some women this may compromise their abdominal strength or ability to perform sit-ups. The recovery phase for this operation is generally about 6 weeks. The amount of discomfort experienced following this operation is generally higher than that associated with the DIEP or SIEA flaps, primarily because with the latter two flaps, there are less structures that are violated.
Marisa Weiss, M.D. With the TRAM, you move the muscle with its blood supply up to the new location, but with the DIEP, don't you actually cut the blood supply and reattach it in the new location? Does the cutting and the attaching of the blood supply make the final tissue flap more vulnerable?
Maurice Nahabedian The DIEP and SIEA flaps require micro-vascular surgery because, in essence, these are tissue transplants. We utilize a microscope to reattach the small artery and vein that supply these tissues to an artery and vein in the vicinity of the mastectomy site.

This micro-vascular technique can be complicated by the formation of blood clots, which can jeopardize the success of these operations. In general, the success rate with these micro-vascular procedures (the DIEP and the SIEA procedures) is in the range of 97 to 98%. The success rate with the TRAM is approximately 99%.

On Wednesday, November 19, 2003, our Ask-the-Expert Online Conference was called Breast Reconstruction. Maurice Nahabedian, M.D. and Marisa Weiss, M.D. answered your questions about different techniques in breast reconstruction, the pros and cons of implants and body tissue transfers, when you might want to reconstruct, and many more issues related to rebuilding your breast/s after breast cancer surgery.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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