GAP stands for gluteal artery perforator, a blood vessel that runs through your buttocks. An SGAP flap (superior gluteal artery perforator), or gluteal perforator hip flap, uses this blood vessel, as well as a section of skin and fat from your upper buttocks/hip (the so-called “love handles”) to reconstruct the breast. Because no muscle is used, an SGAP flap is considered a muscle-sparing type of flap.
There is another type of GAP flap, the IGAP (inferior gluteal artery perforator) flap, which uses tissue from the bottom of your buttocks, near the buttock crease.
GAP flaps tend to make the most sense for women who are having both breasts reconstructed but can’t use tissue from the abdomen -- either because the abdomen is thin or has been damaged by other previous major surgeries there, such as a tummy tuck.
In the SGAP or hip flap surgery, fat, skin, and blood vessels are cut from your upper buttocks/hip and moved up to your chest to rebuild your breasts. Your surgeon carefully reattaches the blood vessels of the flap to blood vessels in your chest using microsurgery. Because skin and fat are moved from the buttocks to the chest, having the SGAP flap can mean your buttocks will be tighter -- as if you had a buttock lift. The SGAP flap leaves a scar near the top of your buttocks, but it's almost always covered by a bikini bottom or underwear.
The SGAP surgery removes tissue from high on the hip to avoid placing the surgical site in a potentially weight-bearing area, as the IGAP approach does. Also, tightening the buttock is more effective when pulling more above, much like “pulling up your pants.” The IGAP is less favorable because fat is removed from the area over your ischium, the large weight-bearing bone in your pelvis. This is where you bear your weight when you are sitting. It also produces some numbness around the incision site, which may be a concern for the formation of pressure-related wounds.
SGAP/hip flap surgery is more technically difficult than a TRAM, DIEP, or SIEA flap and usually takes more time to do. There are not many plastic surgeons who are trained to do it, so you may have to search for one if you’re interested in this procedure. An SGAP flap may be a good choice for thin women who don't have enough extra belly tissue for a TRAM, DIEP, or SIEA flap. If you've previously had liposuction on your buttocks, you may not be a good candidate for SGAP/hip flap reconstruction because you may not have enough extra tissue available. You can consult with your surgeon about your individual situation to determine whether or not you have enough tissue.
Learn more about SGAP/hip flap reconstruction on these pages:
Photographs included in this section are images of surgical procedures performed by the Center for Restorative Breast Surgery and have been generously donated to Breastcancer.org.