Breast Reconstruction With Gluteal Artery Perforator (GAP) Flaps

Abstract

Fujino was the first to introduce gluteal tissue as a free flap for breast reconstruction. The use of the musculocutaneous flap from the buttock in breast reconstruction has been championed by Shaw. Despite the initial enthusiasm for this area as a donor site, few other large series exist on the subject. Two decades of experience with this region as a donor site led to recognition of advantages and drawbacks. Furthermore, use of both the superior and inferior gluteal musculocutaneous flap was associated with certain important donor site complications and the use of vein grafts to allow for microvascular anastomosis. The evolution of free tissue transfer has progressed to the level of the perforator flap. This reconstructive technique allows elevation of tissue from any region consisting only of fat and skin. This minimizes donor site morbidity by allowing preservation of the underlying muscle and coverage of important structures in the region such as nerves. The superior and inferior gluteal perforator flaps have been used at our institution for breast reconstruction since 1993. The superior gluteal artery perforator (S-GAP) flap is our preferred method of breast reconstruction when the abdomen is not available or preferable. We report the result of this flap over the past 9 years and point out important surgical refinements, advantages, disadvantages, and lessons learned during this time.

Donor-site morbidity of the inferior gluteal artery perforator flap for breast reconstruction in teenagers

“…Some reports on the IGAP flap have presented outcomes on the donor site, but none have quantitative or objective data. Dysesthesia on the posterior thigh and contour deformity were recurrent complaints of patients in these studies (5,7,9,12,16).…”

Skin-Sparing Mastectomy and Breast Reconstruction: An Update for Clinical Practice

“…In a study of 142 GAP flaps, the superior-GAP flap was found to have significant advantages over the inferior-GAP flap. Guerra et al reported low morbidity, 98% flap survival, good cosmetic results and high levels of patient satisfaction [50].…”

Breast Reconstruction with DIEP and S/IGAP

“…Perforating vessels are found off of the superior branch of the superior gluteal artery. 27,28 Pre-operatively CTA or MRA has greatly impacted planning of this procedure.…”