GAP stands for gluteal artery perforator, a blood vessel that runs through your buttocks. A GAP flap uses this blood vessel, as well as a section of skin and fat from your buttocks (from the "love handles" on the hips or near the buttock crease) to reconstruct the breast. Because no muscle is used, a GAP flap is considered a muscle-sparing type of flap.
There are two types of GAP flaps:
- SGAP (superior gluteal artery perforator) flap
- IGAP (inferior gluteal artery perforator) flap
The gluteal artery has two sections, one more toward the top of your buttocks (the superior gluteal artery perforator), used for the SGAP, and one more toward the bottom of your buttocks, near the buttock crease (inferior gluteal artery perforator), used for the IGAP. This portion of the gluteal artery used is really the only difference between the two GAP flaps.
In both GAP flaps, fat, skin, and blood vessels are cut from your buttocks and moved up to your chest to rebuild your breast. 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 either type of GAP 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 IGAP flap scar is hidden in the crease of your buttocks.
Either GAP flap surgery is more technically difficult than a TRAM, DIEP, or SIEA flap and usually takes more time to do. An SGAP flap or an IGAP flap is a good choice for thin women who don't have enough extra belly tissue for a TRAM, DIEP, or SIEA flap or for women who plan on getting pregnant. If you've previously had liposuction on your buttocks, you're not a good candidate for GAP flap reconstruction because you likely don't have enough extra tissue available.
Learn more about GAP flap reconstruction on these pages: