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SIEA versus DIEP Arterial Complications: A Cohort Study

Coroneos, Christopher J. M.D., M.Sc.; Heller, Adrian M. M.D.; Voineskos, Sophocles H. M.D., M.Sc.; Avram, Ronen M.D., M.Sc.

Plastic and Reconstructive Surgery: May 2015 - Volume 135 - Issue 5 - p 802e–807e
doi: 10.1097/PRS.0000000000001150
Breast: Original Articles

Background: The authors analyzed arterial complications in patients undergoing breast reconstruction with superficial inferior epigastric artery (SIEA) flaps compared with deep inferior epigastric artery perforator (DIEP) flaps. The variability, caliber, and angiosome of the SIEA are cited as limitations. Experts currently limit SIEA reconstruction to cases with favorable arterial anatomy on preoperative imaging.

Methods: In this retrospective cohort study, consecutive flaps for breast reconstruction from the initial 7 years of a single microsurgeon’s practice (2007 to 2013) were reviewed. Preoperative imaging was not used. Consistent intraoperative criteria for SIEA flap selection were used. All complications were abstracted independently in duplicate using a standardized form and a priori criteria.

Results: One hundred sixty-nine free flaps (SIEA, n = 44; DIEP, n = 125) were performed on 112 patients for unilateral or bilateral breast reconstruction. Significantly more SIEA flaps required reexploration versus DIEP flaps (20 percent versus 7 percent; p = 0.03). Arterial insufficiency was significantly higher among SIEA flaps (14 percent versus 1 percent; p = 0.001). There was no difference in venous insufficiency (p = 0.92). Significantly more SIEA flaps had necrosis requiring intervention (p = 0.03). Ultimately, significantly more SIEA flaps failed completely (14 percent versus 2 percent; p < 0.01). All SIEA flap failures were attributable to arterial thrombosis.

Conclusions: Compared with DIEP flaps, SIEA flaps had significantly higher proportions of reexploration, arterial complication, necrosis, and failure. No difference in venous complications was found. DIEP outcomes agree with existing literature from specialized centers. Complications and failures in SIEA flaps were attributed to arterial thrombosis. Given the authors’ practice setting, SIEA flaps are no longer performed.


Hamilton, Ontario, Canada

From the Division of Plastic Surgery, Department of Surgery, McMaster University.

Received for publication September 22, 2014; accepted October 28, 2014.

Presented at the 15th International Course on Perforator Flaps, in New York, New York, November 22 through 24, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Ronen Avram, M.D., M.Sc., Juravinski Hospital and Cancer Centre, B3-149, 711 Concession Street, Hamilton, Ontario L8V 1C3, Canada,

©2015American Society of Plastic Surgeons