(A)The superior gluteal artery and vein provide the blood supply to the skin and fatty tissue of the upper buttock while the inferior gluteal artery and vein supply the skin and fatty tissue of the lower buttock. These vessels can be used to create a superior gluteal artery perforator (SGAP) flap from the upper buttock, and an inferior gluteal artery perforator (IGAP) flap from the lower buttock tissue. (B) Both SGAP and IGAP flaps are shown being surgically elevated from the buttock; with either flap, the gluteal muscles are left intact at the donor site. (C) The scars that result from harvest of SGAP and IGAP flaps are generally well concealed in clothing. Nonetheless, because harvest of these flaps can cause unfavorable contour changes at the buttock, we seldom perform these procedures any longer, and instead, favor alternatives such as the lumbar artery perforator flap (LAP).
Although the abdomen (DIEP flap), flanks (Extended DIEP flap) and lumbar region (LAP flap) are generally first choices for perforator-flap breast reconstruction, not every women is a good candidate for a flap harvested from these areas. This may be the result of prior surgery or simply because of the amount of tissue available in these areas, which varies from one person to the next. The buttock is an alternative donor site. A flap taken from this site, known as the gluteal artery perforator flap or “GAP flap,” can be used for breast reconstruction. As is the case with the DIEP flap, muscle is left in place at the GAP flap donor sites to preserve function and make recovery easier.
With GAP flaps, tissue for breast reconstruction can be harvested from either the upper or lower buttock, depending upon body shape and personal preference. The blood vessels needed for either an SGAP or IGAP flap are meticulously separated from the gluteus maximus muscles in which they travel without removing any muscle.
The superior gluteal artery is employed when the upper buttock tissue is used for the reconstruction. Sometimes, it is possible to take tissue from the from the “love handle” area just above the buttock using a technique called LAP flap reconstruction. The shape of a women’s body will be an important factor in determining which procedure to perform.
The IGAP flap is harvested from the lower buttock. The scar that results from harvest of this flap is designed to lie within the natural lower buttock crease. The IGAP flap is seldom used any more as it has generally been supplanted by the PAP flap.
The blood vessels that are incorporated into an IGAP or SGAP flap are connected to blood vessels at the mastectomy site using microsurgical techniques. After the blood vessels of the flap are connected, a GAP flap is shaped into a new breast.
Please Contact us if you would like more information about SGAP flaps, IGAP flaps, LAP flaps or PAP flaps for breast reconstruction, or for information about other options for breast reconstruction including DIEP flap surgery after mastectomy. Our practice has offices in New York City; in Fairfield County in Greenwich Connecticut; and on the campus of Vassar Brothers Medical Center, in the Hudson Valley.