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Autologous Breast Reconstruction with SIEA Flaps: An Alternative in Selected Cases

  • Original Article
  • Breast Surgery
  • Published:
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Abstract

Background

The deep inferior epigastric perforator flap has been shown to be a reliable option for autologous breast reconstruction. A further refinement in the transfer of lower abdominal tissue is the superficial inferior epigastric artery (SIEA) flap that does not require any incision of the rectus abdominis fascia or muscle and is superior regarding donor-site morbidity.

Objectives

We conducted a retrospective study to assess reliability and outcomes of autologous breast reconstruction using SIEA flaps.

Methods

We performed autologous breast reconstruction in 1708 patients at our department between 2009 and 2018. Of those, 28 patients that underwent breast reconstruction using a SIEA flap were included for a retrospective chart review.

Results

Given an overall flap loss rate of 1.8%, we observed total flap necrosis following a SIEA flap in four patients (13%). All cases were secondary to arterial thrombosis. We further recognized a significant correlation between flap failure and a history of spontaneous deep vein thrombosis (p < 0.0001). There was no statistically significant relationship between flap failure and obesity (BMI > 30 kg/m2;p = 0.9) or flap failure and a history of abdominal operations (p = 0.6).

Conclusions

The SIEA flap provides a reasonable option for autologous breast reconstruction with the great advantage of minimal donor-site morbidity. Nevertheless, its use should be preserved to selected cases with favorable anatomy. We therefore recommend proper patient selection based on preoperative computed tomography angiography, intraoperative clinical evaluation and history of hypercoagulable state.

Level of Evidence IV

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Authors and Affiliations

  1. Department of Plastic and Aesthetic Surgery, Sana Kliniken Düsseldorf, Gräulinger Strasse 120, 40625, Düsseldorf, Germany

    Lisanne Grünherz, Andreas Wolter, Christoph Andree, Lukas Grüter, Katinka Staemmler, Beatrix Munder, Tino Schulz, Peter Stambera, Mazen Hagouan, Olaf Fleischer, Katrin Seidenstücker, Alina Abu-Gazaleh, Sonia Fertsch, Mohammed Aldeeri, Firas Kour, Julia Kornetka & Birgit Aufmesser

  2. Department of Plastic and Reconstructive Surgery, University Hospital Zurich, Zurich, Switzerland

    Lisanne Grünherz

  3. Department of Health, University of Witten-Herdecke, Witten, Germany

    Andreas Wolter & Oliver Christian Thamm

  4. Department of Plastic and Aesthetic Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany

    Oliver Christian Thamm

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  1. Lisanne Grünherz
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Corresponding author

Correspondence to Andreas Wolter.

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The authors declare that they have no conflict of interest to disclose.

Statement of Human and Animal Rights

This article does not contain any studies with human participants or animals performed by any of the authors.

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All patients gave written consent for retrospective chart review and anonymous use of their photographs upon admission.

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Lisanne Grünherz and Andreas Wolter shared first authorship.

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Grünherz, L., Wolter, A., Andree, C. et al. Autologous Breast Reconstruction with SIEA Flaps: An Alternative in Selected Cases. Aesth Plast Surg 44, 299–306 (2020). https://doi.org/10.1007/s00266-019-01554-8

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  • DOI: https://doi.org/10.1007/s00266-019-01554-8

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