Use of the superficial inferior epigastric vein in breast reconstruction with a deep inferior epigastric artery perforator flap

Abstract

BackgroundAutologous breast reconstruction is highly regarded in reconstructive surgery after mastectomy. DIEP flap reconstruction represents the gold standard for autologous breast reconstruction. The major advantages of DIEP flap reconstruction are its adequate volume, large vascular caliber and pedicle length. Despite reliable anatomy, there are procedures where the plastic surgeon's creativity is required, not only to shape the new breast, but also to overcome microsurgical challenges. An important tool in these cases is the superficial epigastric vein (SIEV).Methods150 DIEP flap procedures performed between 2018 and 2021 were retrospectively evaluated for SIEV use. Intraoperative and postoperative data were analyzed. Rate of anastomosis revision, total and partial flap loss, fat necrosis and donor site complications were evaluated.ResultsIn a total of 150 breast reconstructions with a DIEP flap performed in our clinic, the SIEV was used in 5 cases. The indication for using the SIEV was to improve the venous drainage of the flap or as a graft to reconstruct the main artery perforator. Among the 5 cases, no flap loss occurred.ConclusionsUse of the SIEV is an excellent method to expand the microsurgical options in breast reconstruction with DIEP flap surgery. It provides a safe and reliable procedure to improve venous outflow in cases of inadequate outflow from the deep venous system. The SIEV could also provide a very good option for fast and reliable application as an interposition device in case of arterial complications.

A systematic review of the scientific evidence of venous supercharging in autologous breast reconstruction with abdominally based flaps

“…Seven studies reported surgical take backs of which one was an RCT [ 31 ] and six retrospective non-randomised controlled cohort studies (Additional file 5 ) [ 31 , 35 , 38 , 42 , 55 , 57 , 58 ]. In the RCT [ 31 ] and the study with two consecutive series [ 58 ], there were considerable differences in takebacks between the groups, 13% vs. 55% and 1% vs. 10%, respectively.…”

“… ? Varnava, 2023, Germany [ 57 ] Review of centres use of SIEV Case series (retrospective) P1: 150 DIEPs (107 pats) I1: 4 C: 146 NR NR O1. Complications O5.…”

Prophylactic Venous Supercharging in Deep Inferior Epigastric Artery Perforator Flap Surgery: A Retrospective Dual-Center Study

“…In this way, flap venous drainage may be improved in case of insufficient or inadequate outflow arising from the deep venous system alone. 23 The disadvantages of always preserving the SIEV may be prolonged operating times and the possibility of increased donor site complications, such as seroma. 24 Double-vein DIEP flap harvesting does not significantly increase the operative and ischemia times when compared with the single vein procedure.…”