The IGAP flap (inferior gluteal artery perforator) is an autologous tissue flap procedure that uses fat and skin from your lower buttock to create a new breast mound after a mastectomy. None of your gluteal muscle will be cut or moved for an IGAP reconstruction. This procedure is named for the inferior gluteal artery perforator in your lower buttock. Your reconstructed breast won't have the same appearance and sensation as your natural breast, and you will need additional surgery to create a new nipple and areola.
IGAP and SGAP Flap Methods
An IGAP breast reconstruction is very similar to the SGAP procedure, and differs in only one way: IGAP uses tissue taken from your lower buttock, SGAP uses tissue from your upper buttock. Both are free flap reconstructions that use microsurgery to reconnect an artery from your tissue flap to your chest area to create a breast mound. Most women have enough tissue on their buttocks to create a new breast, but if there is not enough tissue, a small implant can be tucked behind your tissue flap to help fill out the size of your new breast. The removal of skin and fat from your buttock is similar to the procedure for a buttock lift, but includes an artery and vein that will supply blood to the transplanted tissue.Advantages and Disadvantages of IGAP
Pros:- good option if you don't have ample tummy fat
- good option for anyone who has enough skin and fat on the lower buttock
- no muscle is cut or moved, speeding recovery time
- buttock lift results from gluteal skin and fat removal
- less than 2% failure rate
- two scars result, because of two surgery sites
- if your IGAP fails, the tissue flap may die, and will have to be completely removed
- if your reconstruction fails, you must wait 6 - 12 months to try again
You're Not a Candidate for an IGAP If:
- you have previously had lower buttock skin and fat removed
- you have had liposuction on your lower buttock
- you smoke – your buttock scar will take a long time to heal, and your fat tissue is more apt to develop into scar tissue
What to Expect During a IGAP Flap Breast Reconstruction
Illustration © Pam Stephan
You will have intravenous sedation or general anesthesia during your mastectomy and reconstruction. Your plastic surgeon will use a skin marker to carefully plan for the incision that will create your skin flap. An ellipse will be drawn across your lower buttock. If you are having a mastectomy and reconstruction at the same time (immediate reconstruction), your general surgeon will remove your breast, sparing as much skin as will be safe to keep.
Moving Fat, Skin and Blood Supply
Illustration © Pam Stephan
Using the skin markings, your surgeon will make an incision on your lower buttock, and raise a layer of skin and fat. Before disconnecting this tissue flap, he will search for the inferior gluteal artery perforator and vein that will give a dependable blood supply to your new breast. These blood vessels will be carefully moved along with your tissue flap.
Closing the IGAP Flap Incision
Illustration © Pam Stephsn
Your buttock incision will be closed and drains may be placed to promote healing and prevent fluid buildup. This incision will be barely noticeable, since it may be low enough to hide in the fold of your buttock. You will have a butt lift as a result of this part of the procedure.
Creating Your New Breast
Illustration © Pam Stephan
Your tissue flap, complete with blood vessels, will be moved up to your mastectomy area. In order to ensure that the tissue will survive in its new location, your surgeon will use microsurgery to reattach the blood vessels in the tissue flap to blood vessels in your chest. Your skin and fat tissue are then reshaped into a breast mound, and sutured into place. The natural contour of the lower buttock makes a good continuation of the curve of your remaining breast skin. Your surgeon may use some marking techniques over the blood vessels, to help hospital staff monitor their healing as you recover. You should expect to have surgical drains in this incision, too, to help with healing.
Recovering from IGAP Flap Breast Reconstruction
Plan on wearing loose, comfortable clothing for the next few weeks. Tight jeans over a buttock incision with drains will be uncomfortable. You should plan on staying in the hospital for three or four days after this surgery, and expect to have nurses keeping an eye on your healing process. About a week after surgery, if your fluid buildup has significantly decreased, you may be able to have your drains removed. You'll have to rest four to six weeks after a IGAP, so make sure someone will be around to do driving and lifting for you.IGAP Flap for Double Mastectomy
If you have enough skin and fat on both buttocks to create two new breasts, you can have a bilateral simultaneous IGAP flap reconstruction after a double mastectomy. If you've already had buttock tissue used for breast reconstruction (SGAP flap) then you must choose a different method (DIEP, lat flap or implant).Special Considerations About the IGAP Flap
The IGAP uses buttock tissue that has a contour similar to the contour of your natural breast, so many plastic surgeons think it results in a better breast reconstruction than an SGAP procedure. IGAP flap is microsurgery, which requires extensive training, skill and experience, in addition to special facilities at your hospital. The sutures used to reconnect the blood vessels are about the same diameter as a strand of your hair. Your surgical team will be using special tools and a high-power microscope to perform the most critical part of this procedure. Choose a surgeon for this reconstruction carefully -- ask plenty of questions until you feel good about your decision.Discuss Breast Reconstruction in the Forum
There are many types of breast reconstruction - implants, TRAM, Latissimus Dorsi, SGAP, DIEP Flap. What procedure did you have? Would you recommend it to anyone else? What went right or wrong with your reconstruction?-
Sources: National Cancer Institute. Surgery Choices for Women with Early-Stage Breast Cancer. Posted 10/22/2004. Breast reconstruction with gluteal artery perforator flaps Jay W. Granzow, Joshua L. Levine, Ernest S. Chiu, Robert J. Allen Journal of Plastic, Reconstructive & Aesthetic Surgery - June 2006 (Vol. 59, Issue 6, Pages 614-621, DOI: 10.1016/j.bjps.2006.01.005)
American Cancer Society. Breast Reconstruction After Mastectomy. Types of Breast Reconstruction. Revised: 09/06/2007.
