IGAP Flap Breast Reconstruction

This is an excellent option for women who do not have enough tissue in the abdomen for undergoing breast reconstruction. In these circumstances, we can use an excess fat and skin from the top or bottom of buttocks.

Most patients are good candidates for undergoing breast reconstruction using the top of the buttocks (SGAP).

Depending on the distribution of fat in the buttocks we will use the top, SGAP flap, vascularized with the superior gluteal artery, which brings together an adequate tissue for our reconstruction and lifting effect (elevation) of the buttocks. The resulting scar is located in the area where it can be covered with underwear.

For women who have excess tissue in the gluteal fold area we would use an IGAP, a flap vascularized by the inferior gluteal artery. The resulting scar is easily hidden under the gluteal fold.

Both IGAP and SGAP can be used for unilateral or bilateral breast reconstruction.

SGAP (Gluteal Artery Perforator Superior)

The specialized surgeon will choose the part of the gluteal depending on the morphology and the anatomy of patients in order to to get the gluteal area where there is an excess of fat. If surgeon chooses the top of the gluteals (SGAP), an elliptical incision (a slit is made in some bodies from the hip to the center of the gluteal) is performed. Then, skin and fat are removed and separated from the upper gluteal muscle artery. After that, the skin and fat are transplanted to the chest area so as to create the new breast. The scar resulting from surgery will appear at the top of the gluteals and can be easily hidden byunderwear.

IGAP (Inferior Gluteal Artery Perforator)

Instead, when the surgeon uses the bottom of the buttocks (IGAP), an option less frequent, the incision is made in the fold located below the buttock. This implies that once the surgery is completed, the scar will be almost completely hidden but for a few months, the patient will feel every time you sit down. Some plastic surgeons reject the this method because of the positioning and the donor scar deformity of fat.

What we need to consider after the operation?

After the operation the patient should wear on a bra in the gluteal zone during at least 2 weeks and a belt like cycling pants for 2-4 weeks in order to prevent the formation of a serosa. However, most patients will be able to wake up and walk the day after surgery and may leave the hospital 3 or 4 days later.

In fact, recovery is usually quite similar DIEP recovery. However, it is normal that discomfort and pain occur in the gluteal area, numbness around the scar (until the nerves regenerate) and difficulties in adopting certain postures such as sitting, lying on his back or crossing your legs.

Finally, as in any microsurgical intervention, there is a risk of microsurgical complications during the first 48 hours. As it happens with the DIEP, if the surgery is performed by an experienced team, there is less than 1% chance of developing postoperative thrombosis or necrosis.

Differences among DIEP-SGAP

Gluteal flaps are a good breast reconstructive option, but when compared to the DIEP, we must accept that the buttock skin is thicker than the abdominal and subcutaneous fat, which impairs the similarity of the new breast regarding natural breast.


  • Surgery: 6 hours
  • Hospitalization: 3-5 days
  • Usual daily activity: 3-4 weeks
  • Sports and vigorous activity: 2-3 months
  • Creating the nipple and areola: 4-6 months

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