{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T00:42:49Z","timestamp":1792888969197,"version":"4.5.0"},"reference-count":31,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The deep inferior epigastric perforator (DIEP) flap is considered the gold standard for autologous breast reconstruction (ABR). Less commonly used abdominal flaps include the superficial inferior epigastric artery (SIEA) and the superficial circumflex iliac artery (SCIA) flaps which are based on the superficial vasculature of the abdominal wall. We sought to compare complication rates between DIEP and superficial system flaps and their associated risk factors.<\/jats:p>\n                  <jats:p>A retrospective chart review of 400 breast cancer patients undergoing abdominally-based free flap breast reconstruction with either a DIEP or superficial flap from January 2017 to December 2023 was performed at a single institution. The primary outcome was breast and abdominal site complications.<\/jats:p>\n                  <jats:p>A total of 638 flaps, 571 (89.4%) DIEP and 67 (10.5%) superficial, were performed with flap complication rates of 27.3 and 22.4%, respectively. At the recipient site, there was a significant difference in the rate of postoperative thrombosis (0.7% vs. 4.5%, p\u2009=\u20090.015); however, there were no differences for flap failure (0.4% vs. 1.5%, p\u2009=\u20090.28) or other flap complications. Donor site outcomes were similar between groups. Although not statistically significant, abdominal bulging was seen in 18 DIEP flap patients compared with none observed in the superficial flap patients (p\u2009=\u20090.24). When controlling for age, BMI, and radiation history, the overall rate of superficial flap and abdominal complications was not statistically significant from the rate of DIEP flap complications (p\u2009=\u20090.576).<\/jats:p>\n                  <jats:p>Compared with DIEP flaps, superficial flaps had significantly higher rates of immediate perioperative thrombosis. However, there were no significant differences in rates of flap failure or other flap complications with superficial flaps compared with DIEP flaps. There was a clinically significant trend toward increased abdominal bulging with the use of DIEP flaps. Our results will help surgeons better understand the risks and benefits associated with superficial flaps for ABR.<\/jats:p>","DOI":"10.1055\/a-2540-0987","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T19:20:31Z","timestamp":1739820031000},"page":"007-015","source":"Crossref","is-referenced-by-count":5,"title":["A Comparison of SIEA\/SCIA and DIEP Flaps for Autologous Breast Reconstruction"],"prefix":"10.1055","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6854-5053","authenticated-orcid":false,"given":"Sydney","family":"Somers","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany","family":"Foley","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Dadzie","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chase","family":"Hart","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine H.","family":"Bautista","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaylee","family":"Scott","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devin","family":"Eddington","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayant P.","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvin C.","family":"Kwok","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,3,11]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1097\/01.sap.0000235448.93245.42","article-title":"The superficial inferior epigastric artery (SIEA) flap: indications for breast reconstruction","volume":"57","author":"D Wolfram","year":"2006","journal-title":"Ann Plast Surg"},{"issue":"08","key":"ref2","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1016\/j.bjps.2005.12.066","article-title":"The versatility of the SIEA flap: a clinical assessment of the vascular territory of the superficial epigastric inferior artery","volume":"60","author":"C Holm","year":"2007","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1002\/micr.20750","article-title":"The variability of the superficial inferior epigastric artery (SIEA) and its angiosome: a clinical anatomical study","volume":"30","author":"W M Rozen","year":"2010","journal-title":"Microsurgery"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"848e","DOI":"10.1097\/PRS.0000000000009044","article-title":"Prospective longitudinal patient-reported satisfaction and health-related quality of life following DIEP flap breast reconstruction: effects of reconstruction timing","volume":"149","author":"O Ochoa","year":"2022","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1097\/01.prs.0000270282.92038.3f","article-title":"An intraoperative algorithm for use of the SIEA flap for breast reconstruction","volume":"120","author":"A J Spiegel","year":"2007","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s00266-019-01554-8","article-title":"Autologous breast reconstruction with SIEA Flaps: an alternative in selected cases","volume":"44","author":"L Gr\u00fcnherz","year":"2020","journal-title":"Aesthetic Plast Surg"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"865e","DOI":"10.1097\/PRS.0000000000008470","article-title":"Strategy in determining the reliability of SIEA flap utilization","volume":"148","author":"A M Hashem","year":"2021","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.bjps.2010.03.012","article-title":"Imaging of the superficial inferior epigastric vascular anatomy and preoperative planning for the SIEA flap using MDCTA","volume":"64","author":"E Fukaya","year":"2011","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1097\/PRS.0b013e3181823c15","article-title":"Comparison of donor-site morbidity of SIEA, DIEP, and muscle-sparing TRAM flaps for breast reconstruction","volume":"122","author":"L C Wu","year":"2008","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/PRS.0000000000004016","article-title":"Complications and patient-reported outcomes after abdominally based breast reconstruction: results of the mastectomy reconstruction outcomes consortium study","volume":"141","author":"J Erdmann-Sager","year":"2018","journal-title":"Plast Reconstr Surg"},{"issue":"10","key":"ref11","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1001\/jamasurg.2018.1687","article-title":"Comparison of 2-year complication rates among common techniques for postmastectomy breast reconstruction","volume":"153","author":"K G Bennett","year":"2018","journal-title":"JAMA Surg"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1097\/00006534-197509000-00001","article-title":"The anatomy of several free flap donor sites","volume":"56","author":"G I Taylor","year":"1975","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1097\/00000637-199110000-00011","article-title":"The free abdominoplasty flap for immediate breast reconstruction","volume":"27","author":"J C Grotting","year":"1991","journal-title":"Ann Plast Surg"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1097\/01.PRS.0000135328.88101.53","article-title":"Breast reconstruction with superficial inferior epigastric artery flaps: a prospective comparison with TRAM and DIEP flaps","volume":"114","author":"P M Chevray","year":"2004","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref15","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1097\/PRS.0b013e31817d60b0","article-title":"A head-to-head comparison between the muscle-sparing free TRAM and the SIEA flaps: is the rate of flap loss worth the gain in abdominal wall function?","volume":"122","author":"J C Selber","year":"2008","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"1e","DOI":"10.1097\/PRS.0000000000001852","article-title":"Superficial inferior epigastric artery: learning curve versus reality","volume":"137","author":"J R Sarik","year":"2016","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref17","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1097\/PRS.0b013e31818a9a3f","article-title":"Interindividual variability of the SIEA angiosome: effects on operative strategies in breast reconstruction","volume":"122","author":"C Holm","year":"2008","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref18","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1055\/a-2199-3960","article-title":"Superficial inferior epigastric artery flap: vascular pattern and territory across the midline","volume":"40","author":"S Lohasammakul","year":"2024","journal-title":"J Reconstr Microsurg"},{"issue":"04","key":"ref19","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1055\/s-0041-1733976","article-title":"Novel classification of the branching patterns of the superficial branch and the deep branch of the superficial circumflex iliac artery and the superficial inferior epigastric artery on computed tomographic angiography","volume":"38","author":"Y Fuse","year":"2022","journal-title":"J Reconstr Microsurg"},{"issue":"02","key":"ref20","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1055\/a-1887-7274","article-title":"Maximizing the versatility of thin flap from the groin area as a workhorse flap: the selective use of superficial circumflex iliac artery perforator (SCIP) free flap and superficial inferior epigastric artery (SIEA) free flap with precise preoperative planning","volume":"39","author":"H B Kim","year":"2023","journal-title":"J Reconstr Microsurg"},{"issue":"06","key":"ref21","doi-asserted-by":"crossref","first-page":"1682","DOI":"10.1097\/PRS.0000000000002158","article-title":"Breast reconstruction with SIEA flaps: a single-institution experience with 145 free flaps","volume":"137","author":"J E Park","year":"2016","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref22","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1097\/PRS.0b013e318180ed8b","article-title":"Avoiding denervation of rectus abdominis in DIEP flap harvest: the importance of medial row perforators","volume":"122","author":"W M Rozen","year":"2008","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref23","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1080\/2000656X.2018.1498790","article-title":"Factors that predict deep inferior epigastric perforator flap donor site hernia and bulge","volume":"52","author":"D P Butler","year":"2018","journal-title":"J Plast Surg Hand Surg"},{"issue":"09","key":"ref24","doi-asserted-by":"crossref","first-page":"2194","DOI":"10.1016\/j.bjps.2020.12.044","article-title":"Abdominal weakness, bulge, or hernia after DIEP flaps: An algorithm of management, prevention, and surgical repair with classification","volume":"74","author":"N T Haddock","year":"2021","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"02","key":"ref25","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1097\/01.sap.0000147174.31409.3a","article-title":"Lower abdominal bulge after deep inferior epigastric perforator flap (DIEP) breast reconstruction","volume":"54","author":"M Y Nahabedian","year":"2005","journal-title":"Ann Plast Surg"},{"issue":"06","key":"ref26","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/j.bjps.2017.03.011","article-title":"Predicting and planning for SIEA flap utilisation in breast reconstruction: an algorithm combining pre-operative computed tomography analysis and intra-operative angiosome assessment","volume":"70","author":"F P Henry","year":"2017","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"08","key":"ref27","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1016\/j.bjps.2020.12.043","article-title":"Impact of body mass index on free DIEP flap breast reconstruction: a multicenter cohort study","volume":"74","author":"P I Heidekrueger","year":"2021","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"02","key":"ref28","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1055\/s-0043-1769746","article-title":"The effect of body mass index on free flap breast reconstruction","volume":"40","author":"J D Sudduth","year":"2024","journal-title":"J Reconstr Microsurg"},{"issue":"06","key":"ref29","doi-asserted-by":"crossref","first-page":"840e","DOI":"10.1097\/PRS.0000000000004990","article-title":"Assessing age as a risk factor for complications in autologous breast reconstruction","volume":"142","author":"R Torabi","year":"2018","journal-title":"Plast Reconstr Surg"},{"issue":"12","key":"ref30","doi-asserted-by":"crossref","first-page":"3260","DOI":"10.1016\/j.bjps.2021.08.005","article-title":"Does post-mastectomy radiation therapy worsen outcomes in immediate autologous breast flap reconstruction? A systematic review and meta-analysis","volume":"74","author":"B Liew","year":"2021","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"06","key":"ref31","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1097\/SAP.0000000000002628","article-title":"Effect of radiation therapy on microsurgical deep inferior epigastric perforator flap breast reconstructions: a matched cohort analysis of 4577 cases","volume":"86","author":"L Prantl","year":"2021","journal-title":"Ann Plast Surg"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2540-0987.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T23:39:35Z","timestamp":1766792375000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2540-0987"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,17]]},"references-count":31,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2025,12,26]]},"published-print":{"date-parts":[[2026,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2540-0987","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,2,17]]},"published":{"date-parts":[[2025,2,17]]}}}