Breast Reconstruction Using the Superficial Circumflex Iliac Artery Superficial Branch Perforator Flap

The deep inferior epigastric perforator flap is the standard for autologous breast reconstruction. One downside is its risk of postsurgical herniation and bulging due to the opening of the rectus fascia and intramuscular dissection of the rectus abdominis muscle. In addition, this part of the surgery is time-consuming. While the superficial inferior epigastric artery perforator flap has been thoroughly described for total autologous breast reconstruction, use of the superficial circumflex iliac artery (SCIA) perforator flap in this field is limited. The authors introduce the use of an extended SCIA perforator flap nourished solely by perforators of the superficial branch of the SCIA for total autologous breast reconstruction. Superficial preparation over the abdominal wall was performed without incising the rectus fascia, dissecting the superficial branch of the SCIA and its accompanying veins and the superficial inferior epigastric vein for additional venous drainage. Four patients underwent successful autologous breast reconstruction with this extended SCIA perforator flap variation. The authors introduce the term SCIA superficial branch perforator flap to standardize the surgical technique for using only perforators of the superficial branch of the SCIA as free flaps. The SCIA superficial branch perforator flap is safe and viable for total autologous breast reconstruction, particularly for women with small to medium-sized breasts and with superficial dominance of the abdominal vascular system.