The SIEA flap is named for the superficial inferior epigastric artery blood vessel that runs just under your skin in your lower abdomen. It’s also called a SIEP flap (superficial inferior epigastric perforator). It 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, while a DIEP flap requires that a small incision be made in the layer that covers the rectus abdominis muscle, called the fascia, the SIEA flap doesn't require this incision.
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. In an SIEA flap, fat, skin, and blood vessels 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 the muscle isn’t disturbed, 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.
Most women aren’t eligible for a SIEA flap, though, for a few different reasons:
- The superficial blood vessels are usually too small to support the flap.
- These vessels have been cut during a previous C-section or hysterectomy.
- These vessels don’t even exist.
During surgery, the surgeon will look at the blood vessels that can provide source 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.
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 one-third of the way 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, the abdomen is closed. No mesh material is required to support the abdominal wall, as may be the case with a TRAM flap. Your navel is then brought back out through a separate incision and reshaped.
Again, SIEA flap breast reconstruction isn’t an option for most women because of the blood vessel size. It's also not a good choice for:
- thin women who don't have enough extra belly tissue
- women who already have had multiple abdominal surgeries
- women who already have had certain abdominal surgeries, including colostomy (surgery that attaches the large intestine to an opening in the abdominal wall), or abdominoplasty (tummy tuck). This does not include midline incisions extending from the belly button to the pubic region or other routine abdominal operations.
- women whose abdominal blood vessels are small or not in the best location to do an SIEA flap. (A new approach called the APEX FlapCM may be useful in this situation, but availability is very limited.)
Learn more about SIEA flap reconstruction on these pages: