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The superficial inferior epigastric artery (SIEA) flap uses fat, blood vessels, nerves and skin from the lower abdomen to create breast tissue. It is different from the DIEP flap because it does not require blood vessels going through or around the abdominal muscles.
When the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about a silicone implant. The biggest advantage of the SIEA flap is that there is no need to follow the blood vessels going through your abdominal muscles. This means the abdominal muscles are undisturbed, so there is minimal risk of abdominal wall weakness. The SIEA flap technique also takes less time than the DIEP flap.
The downside is that the SIEA flap can be used in only 15 percent of patients and it is not possible to determine this prior to surgery. In the operating room your surgeon will evaluate the SIEA blood vessels to determine if this flap is feasible, in which case he/she will preferentially use this technique over the DIEP. Similar to the DIEP flap, you will have the added benefit of an improved abdominal contour.
Your plastic surgeon will do everything possible to make your breasts look and feel natural. Often you will require a final surgery after your SIEA flap in order to make your breasts as symmetric and natural-looking as possible. Creative techniques, such as fat transfer or grafting, may be used to give your silhouette a more natural appearance. You should discuss with your surgeon all of your concerns and expectations for post-surgery appearance and recovery.
SIEA flap surgery requires a hospital stay of three or four days. You will be able to begin eating on the first day after surgery, and you will get out of bed with assistance on the second day. You will be able to walk with minimal assistance on the day of discharge, and while at home you will be able to perform all necessary activities of daily living.
You will also have three to four surgical drains depending on whether one or two breasts are reconstructed. In most circumstances, these drains will remain in for one to two weeks. If they are highly productive, they will stay in longer.
The recovery time for flap reconstruction is four to six weeks to resume most normal activities. You will be sore for about a week or two and then begin to improve every day.