Gluteal Artery Perforator (GAP) Flap Reconstruction
John C. Lincoln Center for Reconstructive and Plastic Surgery
9250 N. Third St., Suite 1003
Phoenix, AZ 85020
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In gluteal artery perforator flap surgery (often called GAP flap reconstruction) after mastectomy, a breast mound is formed from skin, fatty tissue and the blood vessels of the buttock.
SGAP breast reconstruction, or its counterpart IGAP, may be ideal for a patient who is slender or has had previous abdominal surgery, and therefore lacks the excess abdominal fatty tissue required to perform DIEP flap breast reconstruction.
Two common types of GAP flap reconstruction are:
- SGAP breast reconstruction: This procedure harvests skin, fatty tissue and the superior gluteal artery from the upper part of the buttock.
- IGAP breast reconstruction: This procedure harvests skin, fatty tissue and the inferior gluteal artery from the lower part of the buttock.
In either surgery, a tissue flap is created from the buttock without removing muscle tissue of the gluteus maximus. Merely through an incision to the muscle, the perforator vessels are carefully removed. These blood vessels ensure that the transplanted flap will have sufficient blood supply. Because tissue is taken from the patient's own body, the risk of tissue rejection is greatly reduced.
Tissue is transplanted to the chest wall using microsurgery, an extremely sophisticated form of surgery in which a plastic surgeon will use a microscope to reconnect blood vessels with a width of 1 millimeter or less.
Advantages and Disadvantages of GAP Flap Reconstruction
As mentioned above, the primary advantage of a GAP flap reconstruction is that it offers a surgical option for women who lack sufficient abdominal tissue to perform DIEP breast reconstruction. SGAP and IGAP also can be performed bilaterally; in other words, tissue can be harvested from each buttock, following a bilateral mastectomy.
A significant disadvantage of GAP flap reconstruction is that it is more difficult to perform and requires more time in surgery, compared with DIEP breast reconstruction.
In a DIEP procedure, a plastic surgeon can dissect abdominal tissue while the general surgeon is performing a mastectomy. By contrast, because an SGAP or IGAP procedure operates on the buttocks, the patient is operated on face-down. She must be repositioned during surgery, so that she is face-up, before the flap can be attached to an artery in the chest, through microsurgery.
Another potential drawback for GAP flap reconstruction is that buttock tissue is somewhat harder to shape into a breast, because it is more fibrous than abdominal tissue.