Venous problems in the harvest TRAM or DIEP flaps remain common vascular complications. Current clinical and anatomical studies suggest that the venous congestion results mainly from poor midline-crossing veins. To solve congestion of the contralateral flap, the SIEVs surperdrainage is one of the solutions, but the efficiency is still unknown. We examined the venous anatomy of the lower abdominal area and the dynamic venous flow of the flaps in 9 fresh cadavers and also checked the perfusion of the flaps in the 68 breast cancer patients using intraoperative ICG angiography before and after declamping the contralateral SIEV. Each cadaveric specimen was radiographed using a soft X-ray system and all clinical cases took preoperative CT angiography. We noted that the venous drainage between the bilateral SIEVs was easier to configure in the supraumbilical area than in the infraumbilical area. Only one to two short polygonal venous networks connect the bilateral SIEVs in the supraumbilical area; however, long and multiple polygonal venous networks connect the bilateral SIEVs in the infraumbilical area, which could be a predisposing factor for venous congestion. During operation most of flaps have shown improved perfusion while 38% presented no change or even worse perfusion after declamping. A small number of the medial branch of the SIEV or different dominency of the venous system may cause poor venous drainage even after superdrainge.

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