S-GAP Flap
A proportion of women request autologous breast reconstruction (using their own tissue), but are too slim with not enough fat tissue in the lower abdomen to perform a DIEP flap. Others may have had a surgical procedure in the past to the abdomen, which has led to a undesirable position of the scars. These woman may be eligible for the superior gluteal artery perforator flap, also known as the S-GAP Flap. In this procedure, excess skin and fat from the upper buttock region is taken without any muscle, and transferred as a free flap to the chest to create the new breast. Microsurgical techniques are used to reconnect the blood supply.
What is the difference between the S-GAP and the DIEP?
Both flaps are perforator flaps, which are tissues consisting only of skin and fat without muscle. One of the differences lies in regard of the consistency of the tissue. The S-GAP flap is more compact than the DIEP. Another important difference is with regard to the post-operative recovery. Patients undergoing a S-GAP flap recover quicker than those with a DIEP flap.
What are the specific risks of the S-GAP flap?
The S-GAP flap is technically more challenging to raise than a DIEP flap. The vessels are smaller and the anatomy more unpredictable. Therefore the failure rate is slightly higher. Donor-site morbidity, other than a small amount of asymmetry, does not occur.
Will there be a significant asymmetry?
According to patient surveys, most women haven't noticed significant asymmetry, which would be visible through their clothing.
Anaesthetic
The operation is performed under general anaesthesia. The operation takes 5-8 hours.
Length of stay
3-5 nights following the operation.
RISKS/POSSIBLE COMPLICATIONS
Early (1-2 days):
Frequent
- Bruising
- Swelling
- Discomfort
Infrequent
- Bleeding (haematoma)
- Infection
- Failure of the flap (approx 2%)
- Partial failure of flap
- Re-operation (approx 4%)
- Wound breakdown
- Necrosis of the mastectomy skin flaps
Later (after one week):
Frequent
- Reduced or no sensation of reconstructed breast
Infrequent
- Scars - abdominal, umbilicus, breast unsightly, lumpy, stretch
- Asymmetry of the buttock
- Seroma
- Fat necrosis
General anaesthetic
- Deep vein thrombosis
- Chest infection
- Allergic reaction to drugs or tape
RECOVERY
Immediately after the operation
- You will feel bruised and sore and there will be some swelling
- Pain is usually moderate and controlled with standard painkillers
- There will be drains in the chest and the buttock, which will be removed between 2-5 days later
- You will be out of bed the next day and over the next few days, will increase the amount of walking
After return home
- Socialising with friends 1-2 weeks
- Return to work at 4 weeks
- Driving at 4 weeks
- Swelling and bruising 6-8 weeks
- Wear buttock compression garment for 5 weeks
- Return to the gym and strenuous activity after 3 months
- Final result at 4-6 months
PERMANENCE OF RESULTS
Permanent.
S-GAP Flap
A proportion of women request autologous breast reconstruction (using their own tissue), but are too slim with not enough fat tissue in the lower abdomen to perform a DIEP flap. Others may have had a surgical procedure in the past to the abdomen, which has led to a undesirable position of the scars. These woman may be eligible for the superior gluteal artery perforator flap, also known as the S-GAP Flap. In this procedure, excess skin and fat from the upper buttock region is taken without any muscle, and transferred as a free flap to the chest to create the new breast. Microsurgical techniques are used to reconnect the blood supply.
What is the difference between the S-GAP and the DIEP?
Both flaps are perforator flaps, which are tissues consisting only of skin and fat without muscle. One of the differences lies in regard of the consistency of the tissue. The S-GAP flap is more compact than the DIEP. Another important difference is with regard to the post-operative recovery. Patients undergoing a S-GAP flap recover quicker than those with a DIEP flap.
What are the specific risks of the S-GAP flap?
The S-GAP flap is technically more challenging to raise than a DIEP flap. The vessels are smaller and the anatomy more unpredictable. Therefore the failure rate is slightly higher. Donor-site morbidity, other than a small amount of asymmetry, does not occur.
Will there be a significant asymmetry?
According to patient surveys, most women haven't noticed significant asymmetry, which would be visible through their clothing.
Anaesthetic
The operation is performed under general anaesthesia. The operation takes 5-8 hours.
Length of stay
3-5 nights following the operation.
RISKS/POSSIBLE COMPLICATIONS
Early (1-2 days):
Frequent
- Bruising
- Swelling
- Discomfort
Infrequent
- Bleeding (haematoma)
- Infection
- Failure of the flap (approx 2%)
- Partial failure of flap
- Re-operation (approx 4%)
- Wound breakdown
- Necrosis of the mastectomy skin flaps
Later (after one week):
Frequent
- Reduced or no sensation of reconstructed breast
Infrequent
- Scars - abdominal, umbilicus, breast unsightly, lumpy, stretch
- Asymmetry of the buttock
- Seroma
- Fat necrosis
General anaesthetic
- Deep vein thrombosis
- Chest infection
- Allergic reaction to drugs or tape
RECOVERY
Immediately after the operation
- You will feel bruised and sore and there will be some swelling
- Pain is usually moderate and controlled with standard painkillers
- There will be drains in the chest and the buttock, which will be removed between 2-5 days later
- You will be out of bed the next day and over the next few days, will increase the amount of walking
After return home
- Socialising with friends 1-2 weeks
- Return to work at 4 weeks
- Driving at 4 weeks
- Swelling and bruising 6-8 weeks
- Wear buttock compression garment for 5 weeks
- Return to the gym and strenuous activity after 3 months
- Final result at 4-6 months
PERMANENCE OF RESULTS
Permanent.
S-GAP Flap
A proportion of women request autologous breast reconstruction (using their own tissue), but are too slim with not enough fat tissue in the lower abdomen to perform a DIEP flap. Others may have had a surgical procedure in the past to the abdomen, which has led to a undesirable position of the scars. These woman may be eligible for the superior gluteal artery perforator flap, also known as the S-GAP Flap. In this procedure, excess skin and fat from the upper buttock region is taken without any muscle, and transferred as a free flap to the chest to create the new breast. Microsurgical techniques are used to reconnect the blood supply.
What is the difference between the S-GAP and the DIEP?
Both flaps are perforator flaps, which are tissues consisting only of skin and fat without muscle. One of the differences lies in regard of the consistency of the tissue. The S-GAP flap is more compact than the DIEP. Another important difference is with regard to the post-operative recovery. Patients undergoing a S-GAP flap recover quicker than those with a DIEP flap.
What are the specific risks of the S-GAP flap?
The S-GAP flap is technically more challenging to raise than a DIEP flap. The vessels are smaller and the anatomy more unpredictable. Therefore the failure rate is slightly higher. Donor-site morbidity, other than a small amount of asymmetry, does not occur.
Will there be a significant asymmetry?
According to patient surveys, most women haven't noticed significant asymmetry, which would be visible through their clothing.
Anaesthetic
The operation is performed under general anaesthesia. The operation takes 5-8 hours.
Length of stay
3-5 nights following the operation.
RISKS/POSSIBLE COMPLICATIONS
Early (1-2 days):
Frequent
- Bruising
- Swelling
- Discomfort
Infrequent
- Bleeding (haematoma)
- Infection
- Failure of the flap (approx 2%)
- Partial failure of flap
- Re-operation (approx 4%)
- Wound breakdown
- Necrosis of the mastectomy skin flaps
Later (after one week):
Frequent
- Reduced or no sensation of reconstructed breast
Infrequent
- Scars - abdominal, umbilicus, breast unsightly, lumpy, stretch
- Asymmetry of the buttock
- Seroma
- Fat necrosis
General anaesthetic
- Deep vein thrombosis
- Chest infection
- Allergic reaction to drugs or tape
RECOVERY
Immediately after the operation
- You will feel bruised and sore and there will be some swelling
- Pain is usually moderate and controlled with standard painkillers
- There will be drains in the chest and the buttock, which will be removed between 2-5 days later
- You will be out of bed the next day and over the next few days, will increase the amount of walking
After return home
- Socialising with friends 1-2 weeks
- Return to work at 4 weeks
- Driving at 4 weeks
- Swelling and bruising 6-8 weeks
- Wear buttock compression garment for 5 weeks
- Return to the gym and strenuous activity after 3 months
- Final result at 4-6 months
PERMANENCE OF RESULTS
Permanent.
Anaesthetic
The operation is performed under general anaesthesia. The operation takes 5-8 hours.
Length of stay
3-5 nights following the operation.
RISKS/POSSIBLE COMPLICATIONS
Early (1-2 days):
Frequent
- Bruising
- Swelling
- Discomfort
Infrequent
- Bleeding (haematoma)
- Infection
- Failure of the flap (approx 2%)
- Partial failure of flap
- Re-operation (approx 4%)
- Wound breakdown
- Necrosis of the mastectomy skin flaps
Later (after one week):
Frequent
- Reduced or no sensation of reconstructed breast
Infrequent
- Scars - abdominal, umbilicus, breast unsightly, lumpy, stretch
- Asymmetry of the buttock
- Seroma
- Fat necrosis
General anaesthetic
- Deep vein thrombosis
- Chest infection
- Allergic reaction to drugs or tape
RECOVERY
Immediately after the operation
- You will feel bruised and sore and there will be some swelling
- Pain is usually moderate and controlled with standard painkillers
- There will be drains in the chest and the buttock, which will be removed between 2-5 days later
- You will be out of bed the next day and over the next few days, will increase the amount of walking
After return home
- Socialising with friends 1-2 weeks
- Return to work at 4 weeks
- Driving at 4 weeks
- Swelling and bruising 6-8 weeks
- Wear buttock compression garment for 5 weeks
- Return to the gym and strenuous activity after 3 months
- Final result at 4-6 months
PERMANENCE OF RESULTS
Permanent.
