SGAP Flap, IGAP Flap, and LAP Flap Reconstruction Procedures

If you’re interested in flap reconstruction but don’t have enough tissue in your abdominal area for DIEP, SIEA, or TRAM flaps, then an SGAP, an IGAP, or a LAP flap procedure may be a good alternative. 

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, to reconstruct the breast. 

Another type of GAP flap, the IGAP flap (inferior gluteal artery perforator), uses tissue from the bottom of your buttocks, near the buttock crease.

LAP flaps are taken from the lower back just above the buttocks (the area commonly referred to as love handles). The LAP (lumbar artery perforator) flap is named for the blood vessel that runs through this area.

SGAP, IGAP, or LAP flap procedures may make sense for you if:

• Sponsor Message

  you’ve had a double mastectomy and want to reconstruct both breasts

• Sponsor Message

  you don’t have enough belly tissue or can’t use any because of scarring from previous major surgeries

These procedures may not be right for you if:

• Sponsor Message

  you don’t want to risk losing some of the natural contours of the buttocks

• Sponsor Message

  you’ve had liposuction on your buttocks or hips and don’t have enough tissue

Note that SGAP, IGAP, and LAP flap reconstruction procedures are more technically difficult than other types of flap reconstruction and aren’t widely available. There aren’t many plastic surgeons who offer these flap options so it may help to ask your cancer care team if they know anyone who specializes in them. 

During an SGAP flap procedure, surgeons make an incision along the top of the buttocks and take skin, fat, and blood vessels to reconstruct the breast. Surgeons then attach the tiny blood vessels in the flap to the blood vessels in the chest using microsurgery.

Although not as common as SGAP flap reconstruction, the IGAP flap procedure is very similar to it, except surgeons make the incision along the bottom of the buttocks. 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, and there is concern about pressure-related wounds.

If you are having either SGAP or IGAP flap surgery on both breasts, many plastic surgeons prefer to perform two different operations scheduled a few months apart. You may want to ask your cancer care team for advice on finding an experienced surgical team that can perform one operation, with two surgeons who each work on different sides of your body at the same time.

SGAP and IGAP are both considered muscle-preserving procedures because surgeons do not cut or remove muscle. After SGAP or IGAP flap surgery, your buttocks feel tighter — as if you’d had a butt lift.

The SGAP flap surgical scar is located near the top of your buttocks and is almost always covered by underwear. The IGAP flap surgical scar runs along the bottom crease of the buttocks and generally isn’t that visible.

SGAP and IGAP flap procedures take from nine to 12 hours.

During a LAP flap procedure, surgeons make an incision above the back of your hip, and take skin, fat, and blood vessels to reconstruct the breast. Surgeons then attach the tiny blood vessels in the flap to the blood vessels in the chest using microsurgery. Because the lumbar vessels are relatively short, surgeons often have to take vessels from the abdominal area or under the arm and attach them to the lumbar vessels to make them longer.

LAP is also considered a muscle-preserving procedure because surgeons do not cut or remove muscle.

The LAP flap surgical scar runs along the waistline where the buttocks and lower back meet and can usually remain pretty well hidden.

LAP flap reconstruction procedures take from nine to 12 hours.

The SGAP, GAP, and LAP flap procedures require a hospital stay of about four days. Recovery can take from six to eight weeks. 

You may need help taking care of the incision, and it may be uncomfortable for you to sit down or lie on your back while you heal.

Follow your surgeon’s instructions after surgery and keep the area clean, dry, and protected.

Follow your surgical team’s instructions on when to start stretching exercises and regular daily activities.

If you used a flap from only one buttock for a one-sided reconstruction, you may wish to have liposuction on the side to make both sides even. Health insurance might not cover these additional procedures. Call your health insurance provider to check. You also may want to ask your surgeon if there’s a way to avoid unevenness or if another type of flap procedure makes more sense for you.

As with any surgical procedure, SGAP, IGAP, and LAP flap reconstruction surgery has some risk of necrosis and fat necrosis.

During IGAP flap surgery, there is also a small risk that the sciatic nerve can be nicked or damaged, which can result in sciatica. Sciatica is an intense, sharp pain that radiates along the sciatic nerve, which travels from the lower back through the hips and buttocks and down each leg.

It can take as long as a year or more for your tissue to completely heal and for your scars to fade.