The Superficial Vein Only (SVO)-DIEP Flap

The deep inferior epigastric artery perforator (DIEP) flap, often considered the gold standard in autologous breast reconstruction, is reliant on robust arterial inflow and venous outflow. Venous outflow issues remain a critical part in determining the success of the DIEP flap. Previously, the superficial inferior epigastric vein (SIEV) has been used to augment venous outflow, or as a salvage option when flow through the deep inferior epigastric vein is compromised or insufficient. We describe a variant of the DIEP flap, the superficial vein only (SVO)-DIEP, utilizing the deep inferior epigastric artery (DIEA) and the SIEV as a viable alternative when indicated.We conducted a retrospective review of all patients undergoing autologous breast reconstruction by the senior author from July 2015 - March 2020 to identify DIEP flaps whose only source of venous outflow was the SIEV, excluding those performed as a salvage maneuver.We believe the SVO-DIEP flap is an excellent option for the appropriate patient. It is an added tool to make abdominal-based breast reconstruction more reliable and successful. The use of the SIEV in an SVO flap should be considered as part of any routine DIEP flap reconstruction.