A team of plastic surgeons has developed a new approach to breast reconstruction using a flap based solely on the superficial branch of the superficial circumflex iliac artery.
The technique was used in four patients and may offer a safer, faster alternative among female patients who aren't ideal candidates for traditional deep inferior epigastric perforator (DIEP) flap surgery.
The method, called the superficial circumflex iliac artery (SCIA) superficial branch perforator (SCISP) flap, avoids cutting through abdominal muscles and fascia. It uses tissue from the lower abdomen, supplied by vessels branching from the SCIA. These vessels showed consistent anatomy and sufficient diameter in selected patients.
All four of the patients who received the SCISP flap had successful breast reconstruction with no flap loss. Two experienced minor complications: one had delayed wound healing and another had a small area of skin necrosis measuring about 4 cm. Neither affected the final cosmetic outcome.
Prior to surgery, the patients underwent computed tomography angiography to evaluate abdominal vasculature. In 4 of 21 cases, DIEPs were too small. These patients were instead selected for the SCISP flap based on the size and location of their superficial vessels.
Intraoperative findings showed a perforator diameter of at least 1.5 mm was sufficient. Surgeons harvested an 8-cm pedicle, allowing successful anastomosis to the internal mammary artery. The superficial inferior epigastric vein (SIEV) was preserved in most cases to improve venous drainage and prevent congestion.
The SCISP flap was particularly useful in patients with a dominant superficial vascular system. These patients often have smaller DIEP vessels and larger SCIA or superficial inferior epigastric artery (SIEA) vessels. While the SIEA flap is another option, it's absent in approximately 35% of patients and has been linked to higher rates of arterial complications.
Because the SCISP flap avoids disruption of the abdominal fascia, it may reduce risks of hernia and bulging—common concerns in DIEP procedures. It was also faster to prepare, potentially shortening surgical time.
The investigators recommended the SCISP flap as a viable option among patients with small to medium breast volume and low abdominal fat. They emphasized the need for precise terminology, noting that the term "SCIP flap" is often used ambiguously and doesn't indicate whether the blood supply originates from the superficial or deep SCIA branch.
Although based on a small sample, the findings suggested the SCISP flap may be a useful alternative in autologous breast reconstruction. The investigators planned further studies to validate its safety and effectiveness.
The authors declared no conflicts of interest.