The preferential use of Subcutaneous Arteries (SCIA-SB and SIEA) in abdominal-based autologous breast reconstruction with a modified flap design

Background: Despite its many advantages, the deep inferior epigastric artery per- forator !ap requires fascial incision and intramuscular dissection, which can lead to pain and weakening of the abdominal wall. The super"cial inferior epigastric artery (SIEA) !ap offers an alternative to avoid this damage but is often considered unreliable due to its variable anatomy. In this study, we report our experience in autologous breast reconstruction using either the super"cial branch of the super- "cial circum!ex iliac artery (SCIA-SB) or the SIEA as the sole !ap pedicle. Methods: A retrospective study was conducted from August 2022 to December 2023. A total of 17 patients underwent breast reconstruction with 18 !aps (1 bilat- eral and 16 unilateral reconstructions). The SCIA-SB (14 !aps) or SIEA (4 !aps) served as the exclusive arterial sources. Preoperative vessel identi"cation was per- formed using color-coded duplex sonography, and the !ap design was adjusted accordingly. Intraoperative !ap perfusion was assessed via indocyanine green angi- ography. Demographic, intraoperative, and postoperative data were recorded. Results: The mean follow-up was 5.7 months (range: 3–17 mo). Of the 18 !aps, 1 was lost due to arterial insuf"ciency. Partial !ap necrosis requiring revision occurred in 1 case, whereas minor complications (seroma, wound dehiscence, mastectomy skin necrosis, and infection) were observed in 7 patients. Conclusion: In our experience, either the SCIA-SB or SIEA can be successfully used as a pedicle in autologous breast reconstruction, provided that the abdominal !ap design is modi"ed to include their functional angiosomes.