Banking of contra-lateral superficial inferior epigastric vein graft in unilateral deep inferior epigastric artery flap salvage

Low JE, J Plast Reconstr Aesthet Surg, 2025. PMID: 40493997

Problem

Prioritizing reconstructed breast shape over proximity of ipsilateral SIEV to the IMVs can lead to orientation-limited reach for venous congestion cases. Venous congestion remains a meaningful threat in 2-15% of DIEP flap breast reconstruction cases for which the SIEV can serve as a valuable lifeboat.

Solution

In unilateral cases, the authors advocate prophylactic banking of the contralateral superficial inferior epigastric vein (SIEV) from the discarded hemiabdomen to reduce operative time in takebacks.

Technique and Advantages

• Harvest the contralateral SIEV after inset of DIEP flap. The length of SIEV graft can be 12-20cm if dissected into the flap.

• Flush the SIEV graft with heparinized saline on wet gauze to demonstrate patency, side branches, or vessel injury.

• Bank the SIEV graft in the lateral pocket of the DIEP flap close to the axilla

  • Be sure to mark or orient the ends of the vein graft!

• Banking the SIEV graft can reduce operative time during emergency take backs and may help avoid additional scars from other vein graft options (i.e. cephalic turn down). The banked graft can be used to reach IMV or axillary system vein branches.

Conclusion

In unilateral DIEP reconstruction, pre-emptive banking of the contralateral SIEV is a low-cost, low-morbidity maneuver that equips the team with a long autologous vein graft for rapid venous supercharging or pedicle extension if congestion arises—expediting salvage and preserving aesthetics, particularly in delayed/radiated (higher risk) breasts.