The GAP Flap, also known as the Gluteal Artery Perforator Flap, is a type of reconstruction surgery for patients with insufficient fat in the abdominal region for a DIEP Flap. The GAP Flap evolved from the conventional Free Flap and relies on microsurgery to completely preserve source vessels for reliable, safe and permanent breast reconstruction.1 GAP Flap reconstructive surgery takes excess skin and fat from the buttocks. This muscle-sparing procedure requires less time recovering and no loss of function at the donor site. The Gap Flap is unique in that it allows for reconstructed breasts that are full and round even in very thin women.
Gluteal Artery Perforator Flap Surgery In Houston
The dedicated plastic surgeons at My Houston Surgeons are some of the most skilled breast surgery experts in the region and specialize in advanced microvascular reconstruction procedures such as GAP Flap. They have worked with many women seeking breast reconstruction following mastectomy, and understand that this can be an empowering procedure, and for many women, a first step towards feeling like themselves after breast cancer.
Benefits of GAP Flap
The main benefit of the GAP Flap is that it uses the patient’s own tissue for natural breast reconstruction. GAP Flap also has the following benefits:
- Natural looking and feeling results
- Ideal for thin patients without excess abdominal tissue
- Faster recovery after surgery
- More core strength retention
- Avoids complications associated with breast implants
- Sculpts and shapes the donor site (buttocks)
GAP Flap Procedure
The GAP Flap is performed immediately following mastectomy or as a delayed reconstruction weeks, months or even years later.
During the GAP Flap procedure, the surgeon will make an incision along the upper or lower buttocks and harvest a section of tissue including skin, fat, and connecting blood vessels. This tissue will then be transferred to the breast mound, and a new breast will be sculpted with microsurgery and microvascular techniques. We generally prefer to take a staged approach for patients requiring bilateral GAP Flap reconstruction, and to reconstruct each breast in separate surgeries to avoid complications associated with sitting on the incisions.
SGAP Flap and IGAP Flap Donor Sites
During a GAP Flap, excess tissue is taken from a patient’s upper buttock or lower buttock or both (bilateral GAP Flap).2 The upper buttock region is referred to as a Superior Gluteal Artery Perforator Flap (SGAP Flap) and the lower buttock region is referred to as the Inferior Gluteal Artery Perforator Flap (IGAP Flap).
Recovery After GAP Flap Breast Reconstruction
Following the procedure, results will be visible immediately. Patients undergo our enhanced recovery with less pain and faster return to normalcy. Most patients begin walking without assistance the morning after the surgery and are discharged to go home.
It’s typical for patients to have several surgical drains placed in their incisions. Patients can plan to resume their normal daily routines approximately 3-6 weeks after surgery. Discomfort such as pain and tenderness generally subsides after one week, and scars will start to fade after roughly 3 months and continue to improve for up to one year.
Good Candidates For GAP Flap Breast Reconstruction
The ideal candidates for GAP Flap are women who do not have enough abdominal fat for DIEP Flap breast reconstruction. This includes women who have had previous DIEP flap or TRAM procedures, or had previous plastic surgery (like abdominoplasty) or other surgical procedures that have affected the blood vessels necessary to feed DIEP Flap. Additionally patients should not smoke, be in general good health, and have realistic expectations. Patients who have had previous liposuction in the buttock region may not be good candidates as they may not have enough fatty tissue available.3
Breast Reconstruction Blog Posts
1 Journal of Korean Medical Science. Perforator Flap versus Conventional Flap. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414633/. Accessed July 13, 2021.
2 Plastic & Reconstructive Surgery. Redesigned gluteal artery perforator flap for breast reconstruction. Available: https://pubmed.ncbi.nlm.nih.gov/18317122/. Accessed July 13, 2021.
3 BreastCancer.org. SGAP Flap/Hip Flap. Available: https://www.breastcancer.org/treatment/surgery/reconstruction/types/autologous/gap. Accessed July 13, 2021.
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