SIEA Flap Reconstruction Procedure

SIEA flap surgery is a type of abdominal wall flap procedure. The SIEA — or superficial inferior epigastric artery — flap is named for the blood vessel that runs above the muscle layer and just under the skin in the lower abdomen.

An SIEA flap is considered a muscle-sparing type of flap. In fact, it doesn’t disturb the muscle at all, which is a good thing. Surgeons don’t cut or remove muscle and they don’t open the covering (fascia) that encloses the muscle, which means recovery is quick and there is a lower risk of muscle weakness. 

During a SIEA flap procedure, surgeons take the same fat and skin they use in a TRAM or DIEP flap and the superficial blood vessels from the lower belly to reconstruct the breast. Surgeons then attach the tiny blood vessels in the flap to the blood vessels in the chest using microsurgery. Surgeons then bring the navel back out through a separate incision and reshape it. The surgery takes from six to eight hours.

After SIEA flap surgery, your belly feels tighter — as if you’d had a tummy tuck.

The abdominal incision for SIEA flap surgery leaves a scar that runs horizontally from one hip to the other and is located about one-third of the way between the top of your pubic hair and your navel, usually below your bikini line.

SIEA flap procedures are very similar to DIEP flap procedures with a few notable differences:

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  the blood vessels in the belly used to reconstruct the breast with SIEA flaps are different from those used with DIEP flaps

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  SIEA flap procedures don’t require any muscle incision because the blood vessels travel above the muscle — not within the muscle as they do for DIEP flaps

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  SIEA flap blood vessels are often much smaller than the DIEP blood vessels and may sometimes not be adequate to permit blood flow

Surgeons don’t usually recommend SIEA flaps as a first option, however. During surgery, the surgeon looks at the blood vessels that can provide blood to the flap — the SIEA flap vessels and the DIEP flap vessels. The set of vessels that provides the strongest blood flow to the flap determines whether the surgeon performs a SIEA flap or DIEP flap.

SIEA flap surgery requires a hospital stay of about five days. Recovery can take from six to eight weeks. Keep the area clean, dry, and protected, and follow your surgical team’s instructions on when to start walking, stretching exercises, and regular daily activities.

As with any abdominal surgery, you may find it difficult or painful to sit down or to stand up from a sitting position at first. It might also be difficult to get in and out of bed. Your doctor or physical therapist can show you how to move until you heal.

If you have severe pain, tell your surgical team and ask them what medicine you can take.

As with any surgical procedure, SIEA flap reconstruction surgery has some risk of necrosis, fat necrosis, hernia, and muscle weakness.

The risk of hernia is much lower with SIEA flaps than with any type of TRAM flap because SIEA flap procedures don’t require that surgeons cut into the muscle at all. But after any abdominal surgery, there is some risk of hernia.

SIEA flap surgery may not be right for you if:

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  your superficial blood vessels are too small to support the flap

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  the blood vessels needed for the procedure have been previously cut during a C-section, hysterectomy, or other abdominal surgery

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  you don’t have enough belly tissue

It can take as long as a year or more for your tissue to completely heal and for your scars to fade.