Breast Reconstruction with the Superior Gluteal Artery Perforator (S-GAP) Flap

ABSTRACT

Breast reconstruction with autogenous tissue has become increasingly popular during the past several decades. Reconstruction has been successful using many donor sites, but the abdomen remains the overwhelming choice. However, it is estimated that, in 15 to 20% of patients who undergo mastectomy, the abdomen is not suitable as a donor site. The back, buttocks, and thighs can serve as alternative donor sites in those cases. Our group previously described the superior gluteal artery perforator (S-GAP) flap for breast reconstruction.[1] Since 1993, this flap has been used at our institution as a first-line alternative in patients where the abdomen is judged to be inadequate as a donor site. Based on our success with the deep inferior epigastric perforator artery[2] flap, harvesting only fat and skin from the abdomen, we became interested in applying perforator techniques to the gluteal region. Dissection of the vascular structures out of the muscle proved to be advantageous by providing a much longer pedicle and a much easier dissection of the parent vessels when compared with the gluteal myocutaneous flap.[3] In this article we present our 8-year experience with 127 S-GAP flaps. Flap survival was 98%, with an overall complication rate of 17%. Patient satisfaction of the reconstructed breast and donor site has been excellent. Although the technique is not an easy one to learn, it does provide a reliable flap and an excellent esthetic reconstruction. When the abdomen is not available, the authors feel strongly that the S-GAP flap should be used as an alternative site before considering other options for breast reconstruction.

KEYWORD

Superior gluteal artery perforator flap - deep inferior epigastric perforator artery flap - gluteal flap

REFERENCES

• 1 Allen R, Tucker Jr C. Superior gluteal artery perforator free flap for breast reconstruction.  Plast Reconstr Surg . 1995;  95 1207-1211
• 2 Allen R J, Treece P. Deep inferior epigastric perforator flap for breast reconstruction.  Ann Plast Surg . 1994;  32 32-38
• 3 Shaw W W. Breast reconstruction by superior gluteal microvascular free flaps without silicone implants.  Plast Reconstr Surg . 1983;  72 490-501
• 4 Spear S L, Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trends and therapeutic implications.  Plast Reconstr Surg . 2000;  105 930-942
• 5 Mizgala C L, Hartrmapf Jr R C, Bennett G K. Assessment of the abdominal wall after pedicled TRAM flap surgery: 5 to 7 year follow-up of 150 consecutive patients.  Plast Reconstr Surg . 1994;  93 988-1004
• 6 Kaplan J L, Allen R J. Cost-based comparison between perforator flaps and TRAM flaps for breast reconstruction.  Plast Reconstr Surg . 2000;  105 943-955
• 7 Paletta C E, Bostwick III J, Nahai F. The inferior gluteal free flap in breast reconstruction.  Plast Reconstr Surg . 1989;  84 875-883
• 8 Koshima I, Moriguchi T, Soeda S. The gluteal perforator-based flap for repair of sacral pressure sores.  Plast Reconstr Surg . 1993;  91 678-683
• 9 Dupin C L, Allen R J, Glass C A. The internal mammary artery and vein as a recipient site for free-flap breast reconstruction: a report of 110 consecutive cases.  Plast Reconstr Surg . 1996;  98 685-691