GAP Flap

A gluteal artery perforator or GAP flap is an advanced breast reconstruction technique, similar to the DIEP flap, in which Dr. Fisher uses your own excess tissue, not an implant, to create your new breast without removing any underlying muscle or damaging your motor nerves. The advantages are a natural looking and feeling breast made of healthy, soft, living tissue that, unlike an implant, will not need to be replaced.

In this technique, Dr. Fisher removes a flap of skin and fat from either your upper buttock, in which case it is called a superior gluteal artery perforator (SGAP) flap, or your lower buttock, an inferior gluteal artery perforator (IGAP) flap. Although there will be some flattening of the buttock where the flap is removed, it is typically slight. If needed, liposuction can be used on the intact buttock to improve symmetry. All of these options will be discussed with you in detail during your initial consultation.

GAP Flap Christine Fisher MD Austin TX

(A) The inferior gluteal artery and vein supply the skin and fatty tissue of the lower buttock while the superior gluteal artery and vein provide the blood supply to the skin and fatty tissue of the upper buttock. Respectively, these vessels provide the structure for the inferior gluteal artery perforator (IGAP) flap which uses tissue from the lower buttock, and the superior gluteal artery perforator (SGAP) flap which uses tissue from the upper buttock. (B) An SGAP flap is shown here as it is surgically elevated from the upper buttock; with either flap, the gluteus muscles are left intact at the donor site. The IGAP flap is elevated in a similar manner from the tissue of the lower buttock. (C) The scar that results from harvest of an SGAP flap is shown here. The scar from an IGAP flap lies lower on the buttock or in the lower buttock crease. Once removed from the donor site, a GAP flap is transferred to the chest (not shown) and its blood vessels are connected to blood vessels at the recipient site using microsurgical techniques. The scar that results on the breast will depend on the technique used for the mastectomy.

A GAP flap is an appropriate option for patients without enough abdominal skin and fat for a DIEP flap or who have already had liposuction or a tummy tuck.

Once Dr. Fisher has removed the flap from your buttock, she then carefully shapes it to replace the removed breast tissue and transfer it to your chest. The blood vessels are connected to those in your chest wall or under your arm. It is this part of the procedure in particular, severing the very small blood vessels and reconnecting them using a microscope, that requires advanced technical skills, experience and microsurgery training.

The GAP flap technique requires more initial operating time than an implant reconstruction, but the reconstruction is complete in one surgery.

Your recovery requires several days of rest in the hospital to monitor the flap before you are sent home. Most patients can expect to be sore and have less energy for the first couple of weeks after surgery, can resume light activity such as walks and driving after two weeks, and should avoid heavy lifting or strenuous exercise for at least six weeks.

In many cases, the nipple can be reconstructed at the time of your first breast reconstruction surgery. Otherwise, three months after your initial surgery the nipple will be reconstructed as part of a second touch-up surgery. Three dimensional areola tattooing is also available in the office to add color to the areola and the appearance of texture to the reconstructed nipple. The end result is a breast that looks, feels and moves like a natural part of your body — because it is.

To find out more about a GAP flap, or any other breast reconstruction option, call our office to schedule a consultation.

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