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The superior gluteal artery perforator (SGAP) flap uses tissue from the top of the buttocks to create breast tissue. This is usually done if patients do not have adequate skin and tissue in their abdomens, or have had previous abdominal surgeries that may have interfered with blood vessels that the DIEP flap requires.
Breast plastic and reconstructive surgeons at Johns Hopkins Medicine also pioneered the lateral septal gluteal artery perforator (LSGAP), a modification of the SGAP procedure. This flap procedure does not take tissue from the central area of the buttock, thereby lifting the lateral thigh and buttock area while preserving the natural contours. This is a significant advantage over the traditional SGAP flap whereby the buttock contour may become indented. We are one of only two centers in the country, if not the world, performing this specialized version of the SGAP flap.
When the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about a silicone implant. In some cases, you may have the added benefit of a “bottom lift” or similar cosmetic surgery.
For many patients who have had abdominal surgery, SGAPs are the best route to reconstructing a breast that looks and feels similar to the way their breasts felt before cancer treatment.
SGAP flap procedure uses skin and fat tissue from the buttock area to create a new breast following mastectomy. This animated procedure illustrates the surgery.
Your plastic surgeon will do everything possible to make your breasts look and feel as natural as possible. Often you will require a final surgery after your SGAP flap in order to make your breasts as symmetric and natural-looking as possible. Creative techniques, such as fat transfer or grafting, may be used to give your silhouette a more natural appearance. You should discuss with your surgeon all of your concerns and expectations for post-surgery appearance and recovery.
SGAP flap surgery requires a hospital stay of three or four days. You’ll be able to begin eating on the first day after surgery, and you will get out of bed with assistance on the second day. You will be able to walk with minimal assistance on the day of discharge, and while at home you will be able to perform all necessary activities of daily living.
You will have three to four surgical drains depending on whether one or two breasts were reconstructed. In most circumstances, these drains will remain in for one to two weeks. If they are highly productive they will stay in longer.
The recovery time for flap reconstruction is four to six weeks to resume most normal activities. You will be sore for about a week or two and then begin to improve every day.