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restoreSGAP Flap

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SGAP or IGAP flap is ideal for patients who would like to have breast reconstruction using their own tissue but do not have enough excess abdominal fatty tissue present to donate for breast reconstruction. In these patients, Dr. Spiegel can still offer natural tissue reconstruction using excess buttock skin and fat to reconstruct the breasts. This type of flap reconstruction requires microsurgical precision and expertise to reconnect the tiny blood vessels from the flap to the chest. The tissue is then sculpted to reconstruct the breast.

The SGAP flap, or the Superior Gluteal Artery Perforator flap, uses excess tissue from the top part of the buttock to reconstruct the breasts. The tissue is removed without injury to the underlying muscles and results in a slight buttock lift. The resulting scar is easily hidden in a bikini. A variation from this procedure is the IGAP flap, or the Inferior Gluteal Artery Perforator flap. The IGAP flap uses excess tissue from the bottom part of the buttock, near the lower buttock fold.

The SGAP and IGAP flap procedures are considerably more demanding and lengthier than earlier methods of breast reconstruction due to the precise nature of this microsurgical procedure. However, the surgical effort is rewarded by the excellent aesthetic results that can be achieved.


You may be a candidate for SGAP if you are in good general health and:
  • You have undergone or are planning to undergo a mastectomy.
  • You have breast deformity or skin deficit present due to prior breast surgery or radiation therapy.
  • You desire a natural looking and feeling breast reconstructed using your own fat.
  • You would like to have natural tissue reconstruction but do not have enough excess abdominal fat or have had abdominal surgeries in the past.
  • You have excess fatty tissue present to the buttock.
Things to Consider:
  • This is a more technical, and therefore, lengthier and more intensive procedure than other types of breast reconstruction. This will result in a longer surgery and a hospital stay of 3 – 4 days.
  • You will need to be in good general health and will be required to have a cardiac clearance with a stress test prior to being cleared for this procedure.
  • You will need support at home to help during your recovery process.
  • This is a two-stage procedure with the second stage of the procedure occurring no earlier than 3 – 4 months after the first stage.
    • The first stage of the procedure focuses on safely transferring the tissue from the buttock to the breast.
    • The second stage of the procedure focuses on refining the breast shape and volume and addresses symmetry between the breasts.


Benefits of SGAP Reconstruction include:
  • Natural feel and appearance of the breast, reconstructed using your own body’s tissue.
  • Donor site scar on the buttock is easily concealed in the bikini line.
  • Tightened buttock skin at the donor site resulting in slight lift to the buttock

The risks of microsurgical breast reconstruction procedures are mainly related to the possibility of flap loss, because these microsurgical techniques require connection of tiny blood vessels. If there is a problem with the flap, a reexploration procedure is performed. Other risks are related to the length of the surgery but are not a significant factor in healthy patients and all patients are required to have clearance prior to proceeding with surgery.


Patients have a relatively short hospital stay of 3 – 4 days and can return to normal daily activities at approximately four weeks. You will be able to sleep on your back and sit on your buttock immediately after surgery. Most patients can resume all activities without restrictions, including lifting at 2 – 3 months. Due to advanced microsurgical techniques, Dr. Spiegel removes the excess fatty tissue and skin from the buttock without damaging the underlying gluteal muscles. Patients maintain full function of their gluteal muscles after surgery.

As with any surgery, some swelling, bruising, and soreness are to be expected at first. You will be administered pain medication to help control any post-op discomfort. This tenderness and swelling should begin to subside after a few days. The majority of swelling should begin to resolve after a few weeks.


The short and long term results of the SGAP/IGAP flap are excellent. The reconstructed breasts will be natural in look and feel. It is important to note that buttock fat and skin is firmer compared to breast skin and fat. Therefore, the reconstructed breast will be affected less by changes in gravity than your natural breast, but will still age with you, achieving a long-lasting result.

Before & After Images


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