The SIEA flap (also called an SIEP flap) is named for the superficial inferior epigastric artery blood vessel that runs just under your skin in your lower abdomen. An SIEA flap is very similar to a DIEP flap, except that a different section of blood vessels in the belly are moved with the fat and skin. Also, a DIEP flap requires that a small incision be made in the rectus abdominis muscle; the SIEA flap doesn't require this incision. An SIEA flap is considered a muscle-sparing type of flap. An SIEA flap is also called an SIEP (superficial inferior epigastric perforator) flap.
In an SIEA flap, fat, skin, and blood vessels (but no muscle) are cut from the wall of the lower belly and moved up to your chest to rebuild your breast. Your surgeon carefully reattaches the blood vessels of the flap to the blood vessels in your chest using microsurgery. Because no muscle is used, most women recover more quickly and have a lower risk of losing abdominal muscle strength with an SIEA flap compared to any of the TRAM flap procedures.
Because the SIEA flap procedure requires special surgical training and expertise in microsurgery, not all surgeons can do an SIEA flap and it's not available at all hospitals. If you're considering an SIEA flap, you may have to do research to find the surgeons and facilities that offer what you want. Your doctor may be able to refer you to plastic surgeons who specialize in SIEA flap reconstruction.
Tissue can be taken from your belly for breast reconstruction only once. So if you're thinking about prophylactic removal and reconstruction of the other breast, you might want to make that decision before you decide on reconstruction. If you have SIEA flap reconstruction on one breast and then later need reconstruction on your other breast, tissue for the second, later reconstruction will have to come your buttocks or back. Or you can have reconstruction with an implant.
Because skin, fat, and blood vessels are moved from the belly to the chest, having an SIEA flap means your belly will be tighter -- as if you had a tummy tuck. Still, an SIEA flap does leave a long scar -- from hipbone to hipbone -- about halfway between the top of your pubic hair and your navel. In most cases, the scar is below your bikini line. After the skin and fat are removed from your belly, your navel may be in the wrong place or distorted in some way, so your surgeon may have to reshape your belly button.
While SIEA flap breast reconstruction is popular because it doesn't move muscle (which usually means a shorter recovery time than a TRAM flap), an SIEA flap isn't for everyone. It's not a good choice for:
- thin women who don't have enough extra belly tissue
- women who smoke
- women who already have had multiple abdominal surgeries
- women who plan on getting pregnant
Learn more about SIEA flap reconstruction on these pages: