Superficial Inferior Epigastric Artery (SIEA) Flap For Autologous Breast Reconstruction: A Single-Institution Experience With Technical Pearls

Introduction Autologous abdominal tissue transfer is considered the gold standard for breast reconstruction, providing natural composition and texture. The superficial inferior epigastric artery (SIEA) flap represents the least invasive option, sparing both the rectus muscle and fascia. However, its adoption remains limited due to concerns regarding arterial complications and donor site morbidity. We aimed to describe our experience with SIEA flaps in carefully selected patients and present technical pearls to optimise outcomes. Methods A retrospective chart review was performed of all breast cancer patients undergoing abdominal-based free flap breast reconstruction at a single institution from January 2020 to September 2025. Patients were selected for SIEA reconstruction based on preoperative computed tomography angiography (CTA) demonstrating a dominant superficial system (SIEA diameter ≥1.5 mm) with inadequate deep inferior epigastric artery perforator (DIEP) anatomy. Demographic data, comorbidities, adjuvant therapies, operative details, and complications were recorded. Outcomes were compared descriptively with contemporaneous DIEP flap reconstructions. Categorical variables were analyzed using Fisher's exact test, with statistical significance set at p