What Is SIEA Flap?
SIEA flap is made up of superficial inferior epigastric artery blood vessels that run just beneath the skin in the lower belly. Hence the name. It is also known as a SIEP flap (superficial inferior epigastric perforator). This is similar to the DIEP (deep inferior epigastric artery perforator) flap. The only difference between it and a DIEP flap is that a different segment of the stomach's blood arteries is shifted along with the fat and skin. Additionally, the SIEA flap does not require any incision. Still, a small incision is necessary for a DIEP flap to be produced in the fascia, the layer surrounding the rectus abdominis muscle. The significant advantage of SIEA flaps is that the muscles are not relocated, so they are called muscle-sparing flaps. In an SIEA flap, the lower abdomen wall's fat, skin, and blood arteries are removed and transported to the chest to reconstruct the breast. The doctor delicately reconnects the blood vessel.
Who Is a Potential Candidate for SIEA Flap Surgery?
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Ladies with sufficient amounts of abdominal fat.
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Women who have not already undergone several abdominal procedures.
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Women who have already undergone certain abdominal procedures, such as an abdominoplasty (tummy tuck) or colostomy (a procedure that joins the intestinal tract to a hole in the lower abdomen). This includes other standard abdominal procedures and cuts running midline from the abdominal button to the groin area.
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Ladies who are in the optimal position for an SIEA flap and whose stomach blood vessels are not tiny.
Who Are Not Ideal Candidates for SIEA Flap Surgery?
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Individuals who are active smokers.
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Individuals with few superficial blood vessels in the abdomen cannot maintain the flap.
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Women with previous cesarean operations or hysterectomies, where these veins were cut.
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There is no presence of such vessels.
How To Choose a Plastic Surgeon for SIEA Flap?
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A plastic surgeon with specialized training in flap surgery and expertise in microsurgery.
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Always go with a licensed surgeon.
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Make sure the surgeon has at least six years of surgical experience and three years of experience performing plastic surgery. He or she should also be a certified member of the American Society of Plastic Surgeons (ASPS).
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A trained plastic surgeon gives the patient results-guaranteed care.
How Is the Surgical Procedure Done?
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The procedure is performed under general anesthesia.
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An incision is placed along the bikini line during the SIEA flap reconstruction procedure.
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Following that, a section of epidermis, fat, and blood vessels from the lower half of the abdomen are transferred to the chest and shaped into breasts. In an SIEA flap, no muscles are relocated.
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The small and tiny blood vessels inside the flap, the tissue that now constitutes a new breast, are meticulously linked to blood vessels in the chest area and reattached using a microscope.
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The procedure usually takes six to eight hours for a flap reconstruction.
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After an SIEA flap reconstruction procedure, patients will be sent to the recovery area, where medical professionals will monitor their blood pressure, body temperature, and heart rate.
How Should Postoperative Care Be Taken By Patient?
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Patients are advised to follow the medications prescribed by the surgeon to prevent nausea and pain after the surgery.
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After the surgery, patients are supposed to stay in the hospital for five days or more, and a hospital room will be assigned to them.
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They will receive detailed advice from the doctor on how to recuperate.
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The healing process following SIEA flap reconstruction surgery can take six to eight weeks.
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The doctor could advise patients to wear a compression girdle for up to eight weeks following surgery.
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The patient might feel worse than someone who had had a mastectomy as the surgery is done at two different locations on the body (chest and belly), and it will probably take longer to heal.
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Three incisions on the breast, lower abdomen, and the area around the navel will probably require more attention. A fourth incision will need to be taken care of if the patient simultaneously underwent axillary dissection. Patients will likely have drains in the abdominal donor site, reconstructed breast, and under the arm if lymph nodes are removed as well.
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Patients can experience pain or difficulty getting up from a seated posture after abdominal surgery.
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Another potential difficulty is getting in or out of bed. Patients can get moving instructions from the physician or physical therapist as the abdomen region heals. Ask the doctor about them if there is a lot of pain.
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It is crucial to give the necessary time need to recover. Doctors will advise on when to begin exercises and regular routines.
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Following SIEA flap reconstruction, patients often have to wait around six weeks before engaging in sexual activity, intense sports, or lifting anything heavy.
If patients choose to have further "cosmetic" surgery, such as resizing the flap or recreating a nipple, it may take up to a year more for tissue to fully recover and for scars to fade.
What Are the Complications of SIEA Flap surgery?
SIEA flap surgery carries various dangers, just like other types of surgery. Many of the risks of SIEA flap surgery are also related to mastectomy hazards. There are, however, some hazards that are particular to
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Muscle Wasting or Herniation at the Donor Site: Whenever a tiny portion of the intestine comes out through a weak area in a muscle, it is known as a hernia. Abdominal hernias are the most common. They typically appear when a person stresses an abdominal muscle with a weak area, maybe by lifting a heavy object.
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Lumps in the Breast After Reconstruction: If the blood flow is lost to a part of the fat used to reconstruct the breast, the fat may be substituted by thick scar tissue that feels lumpy. This is called fat necrosis. These masses of fat necrosis might or might not disappear on their own. Patients might feel some discomfort as a result of them.
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Tissue Breakdown: Occasionally, tissue transferred from the abdomen to the breast region may not receive enough blood flow, and some of the cells may eventually perish. Necrosis is the medical term for this tissue disintegration. Skin that has turned dark blue or black, a tissue that feels chilly or cool to the touch, and the eventual emergence of open sores are some signs of tissue necrosis. Patients who do not take fast action to treat these symptoms can also get unwell or have a fever. Surgeons can remove the dead tissue from a small region of necrosis if one is discovered. This occurs in the operating room when the patient is asleep or sporadically during a routine procedure if the majority or the entire flap tissue becomes necrotic, which may lead to complete failure of the flap.
Conclusion
SIEA flaps help to reconstruct the breast after mastectomy. To successfully reconstruct the breast utilizing SIEA flaps, rigorous preoperative evaluation of the lower abdomen vascular system and careful presurgical assessment are needed.
