Role of the Superficial Inferior Epigastric System in Breast Reconstruction

Use of the superficial inferior epigastric system has recently been reported in breast reconstruction. The superficial inferior epigastric vein has been used to salvage deep inferior epigastric artery (DIEA) perforator flaps, which have been complicated by insufficient venous drainage. In addition, harvesting the flap, based on the superficial inferior epigastric artery (SIEA), provides an ideal flap for breast reconstruction. However, the flap is used by only a few breast surgeons and with differing results. This study aimed to optimize the results of using the SIEA flap in breast reconstruction, and to describe some maneuvers in using this system to enhance the outcomes of DIEP flaps.

For the past 3 years, there has been a more rational approach in flap selection for breast reconstruction. Currently, the use of the SIEA flap in the authors' patients has increased significantly from 10% in 2002 to 50% in 2003. The SIE vessels are Dopplered and evaluated in every patient with an indication for this flap. The SIEA flap is more suitable for post-mastectomy breast reconstruction when a moderate amount of tissue, basically zones I and II, is required. Including the circumflex iliac vessels within the flap can increase the vascular territory of the SIEA flap. If the SIE vessels are not suitable, the flap is converted to a DIEAP flap. In addition, the SIE vessels can be used to promote the blood supply to, or as an additional venous drainage of, a DIEAP flap. In these clinical situations, the SIE vessels are anastomosed to the lateral branch of the DIE vessels, directly to the internal mammary (IM) vein or to an IM perforator. There has been experience of a total SIEA flap necrosis due to a bad choice of recipient vessels, but by using the right vascular territory, partial and fat necrosis hardly occurs with the SIEA flap. Seroma at the donor site occurred in more than 50% of the cases. Paresthesia over the inner surface of the upper thigh occurred in two patients.

Clinical examples were demonstrated, along with tips about surgical techniques and flap in-setting and shaping. The SIEA flap provides ideal material with minimal donor-site morbidity. The flap does have some drawbacks, but flap-related complications can be reduced significantly if the surgeon considers specific anatomic information. The SIEA flap seems to be the next logical step, or at least back-to-back armamentarium, after perforator flaps for breast reconstruction.