The SGAP flap (superior gluteal artery perforator) is a tissue flap procedure that uses fat and skin from your upper buttock to create a new breast mound after a mastectomy. You won't need to have any gluteal muscle cut or moved for a SGAP reconstruction. This procedure takes its name from the superior gluteal artery perforator in your upper buttock. Your plastic surgeon will use microsurgery to reconnect the artery from your tissue flap to your chest area. Your reconstructed breast will not look and feel exactly the same as your natural breast, and you will need additional surgery to create a nipple and areola.
SGAP Flap Method
During a SGAP flap reconstruction, skin and fat will be moved from your upper buttock up to your chest, and used to create a breast mound. Most women have enough tissue in their gluteal area to create a new breast. But if there is not enough tissue, a small implant can be placed to fill out the size of the 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. The main difference between an SGAP and an IGAP reconstruction procedure is that SGAP uses tissue from your upper buttock, while IGAP uses tissue from your lower buttock to create a tissue flap for transplantation.Advantages and Disadvantages of SGAP
The SGAP is a good option for women who don't have enough tummy fat to use for breast reconstruction. However, anyone who has enough skin and fat on their upper buttock can choose the SGAP procedure. You won't have to have any muscle moved for a SGAP reconstruction, so recovery time will be less than it would for a TRAM or LatFlap procedure. You will have two scars from a SGAP because you will have two surgical sites, but there should be less pain than you'd have after a TRAM or LatFlap. Because gluteal skin and fat are removed, you will have the benefit of a buttock lift. The SGAP flap procedure has a less than 2% failure rate. If a SGAP procedure fails, the tissue flap may die, and will have to be completely removed.You're Not a Candidate If:
- you have previously had upper buttock skin and fat removed
- you have had liposuction on your upper 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
Breast Reconstruction Now or Later
Breast reconstruction can be done during a mastectomy or after treatment. If you need radiation therapy to the underarm area or chest, you should delay. However, it is worth waiting: Having the procedure done before treatment is complete severely limits a radiation therapist's ability to properly treat you.If you are thinking about reconstruction, it's a good idea to talk with your plastic surgeon before having a mastectomy. This gives you the chance to have measurements and pictures taken of your natural breasts, so your reconstructed breast can be recreated as accurately as possible. Your plastic surgeon will offer you a range of options, and can help save skin and prevent unnecessary scars, if you consult him beforehand.
What to Expect During SGAP Flap Breast Reconstruction
Illustration © Pam Stephan
You will not be awake during your mastectomy or reconstruction, so you will have intravenous sedation or general anesthesia. Talk to your surgeon and the anesthesiologist about which will work best for you. If you've had surgery before and experienced trouble with anesthesia, ask if you can be pretreated for nausea. If you are having a mastectomy and reconstruction at the same time (immediate reconstruction), your general surgeon will first remove your breast, sparing as much skin as will be safe to keep.
Getting Ready for SGAP Flap Breast 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 upper buttock, from a point near your hip down to your gluteal crease. This ellipse will become the skin flap that closes the incision for your reconstructed breast. When the incision for this flap is shut, it will become a line that crosses one upper buttock. Your buttock will be lifted as a result of the skin and fat removal.Moving Fat, Skin and Blood Supply
Illustration © Pam Stephan
Your surgeon will make an incision along the marked skin on your upper buttock, and raise a layer of skin and fat. Before disconnecting this tissue flap, he will search for the superior gluteal artery perforator and vein that will bring a dependable blood supply to your new breast. These blood vessels will be carefully preserved along with your tissue flap.
Closing Your Gluteal Incision
Illustration © Pam Stephan
Before placing your SGAP tissue flap in your mastectomy area, your gluteal incision will be closed. Surgical drains may be placed in or near this incision to promote healing and prevent fluid buildup.
Creating Your New Breast
Illustration © Pam Stephan
Your tissue flap, complete with blood vessels, will be relocated 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. Your surgeon may use some marking techniques over the blood vessels to help monitor their healing as you recover. Expect to have surgical drains in this incision, too, to help with healing.
