Body Lift Perforator Flap
Pioneered at the Center for Restorative Breast Surgery, body lift perforator flap reconstruction basically combines DIEP flap reconstruction, which uses tissue from the belly or lower abdomen, with SGAP/hip flap reconstruction, which uses tissue from the upper buttocks. Although not yet widely available, the body lift can be an option for thin women with medium-to-large breasts who want bilateral reconstruction with flaps (as opposed to implants) but don’t have enough tissue in the belly or upper buttocks/hips to recreate the breasts at the desired size. It also can be used for women who want to replace breast implants with tissue flaps.
Body lift perforator flap reconstruction uses a flap of tissue from both sides of the lower abdomen (DIEP) and the upper buttocks (SGAP, or hip flap) to reconstruct the breasts — two flaps per breast, or four flaps in all. DIEP stands for the deep inferior epigastric perforator artery, which runs through the abdomen. SGAP stands for superior gluteal artery perforator. Two plastic surgeons would work together to “harvest” the two DIEP flaps and SGAP flaps. Then they would “stack” the DIEP flap on top of the GAP flap in each breast and use microsurgery to carefully attach the blood vessels in each flap to the vessels in the chest area.
The name “body lift” refers to the fact that, in addition to new breasts, you’d get the results of a tummy tuck from the removal of tissue flaps from the lower abdomen (DIEP) and a butt lift from the SGAP flap removal. The surgery involves an incision along the lower abdomen, or tummy tuck line, that extends around to the hips. The end result is often an improved body contour: less extra tissue in the belly area and on the hips.
Body lift perforator flap surgery is a newer approach to flap surgery that requires special surgical training along with expertise in microsurgery. Few surgeons offer it, so it may be difficult to access it in your area. You may have to do some research to find an experienced surgeon and perhaps travel out of town to access it. Your doctor may be able to refer you to plastic surgeons who can offer body lift perforator flap reconstruction. You can also visit Finding a Qualified Plastic Surgeon for more information.
Body lift perforator flap reconstruction may not be a good choice for:
Women who already have had certain abdominal surgeries, including colostomy (surgery to attach the large intestine to an opening in the abdominal wall) or abdominoplasty (tummy tuck). This does not include midline incisions extending from the belly button to the pubic region or other routine abdominal operations. If you have had a C-section, hysterectomy, gall bladder surgery, appendectomy, or tubal ligation, you may still be a candidate for body lift perforator flap reconstruction.
Women whose abdominal blood vessels are small or not in the best location to undergo the DIEP flaps that are part of this surgery. (A new approach called the APEX FlapCM may be useful in this situation, but availability is very limited.)
Body lift perforator flap reconstruction: What to expect
During body lift perforator flap surgery, an incision is made along your bikini line and the surgeons take out the two flaps of abdominal tissue (or DIEP flaps) that they will use in the reconstruction. For now, the team leaves them attached to their blood supply in the lower belly.
Your body is then carefully turned over so that the surgeons can access your hips/upper buttocks. They extend the same incision made on your lower abdomen around to your back, where they remove a GAP flap from either buttock. The incision is made high on the hip and the team removes only as much fatty tissue as is needed. This helps to preserve a nice shape for the buttock and keeps scars hidden under a bikini or underwear. Since the surgeons are using both sides, less tissue can be taken from each donor site, which also helps make it easier to preserve the overall shape. Once the GAP flaps are removed, the surgeons close the donor sites and carefully turn you onto your back.
Next, the team removes the DIEP flaps completely from the lower abdomen, along with their blood vessels, and the abdomen is closed as in a tummy tuck procedure. The surgeons then place the GAP flaps into the breast pocket first followed by the DIEP flaps on top. The tiny blood vessels in the flaps, which will feed the tissue of your new breasts, are matched to blood vessels in your chest and carefully reattached under a microscope. The flaps are also linked together microsurgically to provide blood flow throughout the entire new breast.
Body lift perforator flap reconstruction surgery takes about 9-10 hours.
After body lift perforator flap reconstruction surgery: You'll be moved to the recovery room after surgery, where hospital staff members will monitor your heart rate, body temperature, and blood pressure. If you're in pain or feel nauseated from the anesthesia, tell someone so you can be given medication.
You'll then be admitted to a hospital room. For body lift perforator flap surgery, you usually stay in the hospital for about 3-4 days.
Your doctor will give you specific instructions to follow for your recovery. For detailed information on how to care for the dressings, stitches, staples, and surgical drains, visit the Mastectomy: What to Expect page.
If you had immediate reconstruction, it can take about 6 to 8 weeks to recover from body lift perforator flap reconstruction surgery. Your doctor may recommend that you wear a compression girdle for up to 8 weeks after surgery. Because you've had surgery at multiple sites on your body (your chest, your belly, your hips), you can expect it to take longer to recover than someone having mastectomy alone. You'll have to take care of multiple incisions: on your breasts, your lower abdomen, around your belly button, and your upper buttocks, and you'll probably have drains in your reconstructed breast and in your tissue donor sites. If you had axillary nodes removed during this surgery, you will have another incision under your arm(s).
As with any major abdominal/hip surgery, you may find that it's difficult or painful to sit down or get up from a sitting position. It also might be hard to get in and out of bed. Your doctor can show you how to move until your abdominal area heals. If you have severe pain, ask your doctor about medications you can take.
It's important to take the time you need to heal. Follow your doctor's advice on when to start stretching exercises and your normal activities. You usually have to avoid lifting anything heavy, strenuous sports, and sexual activity for about 6 weeks after body lift flap reconstruction.
Body lift perforator flap surgery risks
Like all surgery, body lift perforator flap surgery has some risks. Many of the risks associated with this surgery are the same as the risks for mastectomy. However, there are some risks specific to body lift perforator flap reconstruction; generally they’re the same as the risks of DIEP flap and GAP flap surgery, since body lift basically combines these two procedures.
Tissue breakdown: In rare instances, the tissue moved from your belly and upper buttocks to your breast area won't get enough circulation and some of the tissue might die. Doctors call this tissue breakdown “necrosis.” Some symptoms of tissue necrosis include the skin turning dark blue or black, a cold or cool-to-the-touch feeling in the tissue, and even the eventual development of open wounds. You also may run a fever or feel sick if these symptoms are not addressed immediately. If a small area of necrosis is found, your surgeon can trim away the dead tissue. This is done in the operating room under general anesthesia or occasionally in a minor procedure setting. If most or all of the flap tissue develops necrosis, your doctor may call this a “complete flap failure,” which means the entire flap would need to be removed and replaced. Sometimes the flap can be replaced within a short timeframe, but in most cases the surgical team will remove all the dead tissue and allow the area to heal before identifying a new donor site to create a new flap.
If the tissue isn’t getting enough blood supply, you’ll know it within a few days after surgery based on the appearance of these symptoms. Otherwise, you know the tissue is getting enough blood supply and long-term problems with tissue breakdown are not a concern.
Lumps in the reconstructed breast(s): If the blood supply to some of the fat used to rebuild your breast is cut off, the fat may be replaced by firm scar tissue that will feel like a lump. This is called fat necrosis. These fat necrosis lumps may or may not go away on their own. If they don't, it's best to have your surgeon remove them. After having mastectomy and reconstruction, it can be a little scary to find another lump in your rebuilt breast. Having it removed can give you greater peace of mind, as well as ease any discomfort you might have.
Hernia or muscle weakness at the donor site: A hernia happens when part of an internal organ (often a small piece of the intestine) bulges through a weak spot in a muscle. Most hernias occur in the abdomen. They usually develop when someone who has a weak spot in an abdominal muscle strains the muscle, perhaps by lifting something heavy.
If you have a body lift perforator flap, you have a very small risk of hernia due to the removal of the DIEP flap. Hernias can be painful and can cause a noticeable bulge in your abdomen. Hernias usually are treated by surgically repairing the opening in the muscle wall. There also is a small risk of residual muscle weakness. DIEP flap removal does preserve the abdominal wall, though, so both risks are quite small.
— Last updated on February 9, 2022, 8:32 PM