Types of Reconstruction Surgery – the GAP flap (incl IGAP, SGAP)

Types of Reconstruction Surgery the GAP flap
Photo courtesy of freedigitalphotos.net and duron123

When I first decided to write about all the different types of reconstruction surgery, I had no idea how many types there were!  Even in the eight years since I had breast cancer, this type of surgery has come a long way and I certainly did not have as many options back then as there are today.

Deciding which type of reconstruction surgery to have will be quite difficult for some, so I’m hoping that this series of articles assists someone in making that decision.

My suggestion?  Make sure you discuss your options thoroughly with your surgeon so that you know all of the pros and cons each type of reconstruction surgery will entail and choose the one that makes sense for you and your lifestyle.


This type of breast reconstruction is generally utilized when a patient does not have sufficient tummy fat to have TRAM or DIEP flaps. The GAP (gluteal artery perforator) uses skin and fat from your tushy (buttocks) and depending on whether your surgeon uses the upper portion (SGAP = superior gluteal artery perforator) or the lower portion (IGAP, inferior gluteal artery perforator) will be a decision that you either make together, or solely by your surgeon in the operating room.

The GAP blood vessels are not located within muscle, so your gluteus maximus will be undisturbed during this procedure except for an incision which your surgeon makes to tease the perforator vessels out of the gluteal muscle to create the blood vessels for the transplanted tissue.

Here’s a great little YouTube video put out by Johns Hopkins to illustrate this type of flap procedure.

Most women have enough tissue in their gluteal area to create a new breast, however, if there is not enough tissue, a small implant can be placed to fill out the size of the new breast.

This type of flap can be taken from one buttock, or can be harvested from both buttocks for bilateral breast reconstruction.  Flap elevation is completed while the patient is sleeping (under anesthesia, of course) face down, and then the patient is turned over for the flap to be attached to the chest.

This is another procedure which requires a high degree of proficiency from your surgeon – it’s microsurgery.  Please ensure that your surgeon has the requisite experience and skills.

Length of Surgery: for one breast, 5-7 hours, for both breasts, 7-12 hours (this may vary according to your surgical team).

Hospital Stay: 3-4 days (ask your particular surgeon for more information as this varies between hospitals and surgeons)

From A Practical Point of View…

Because no muscle is moved during this operation, most women said the recovery period wasn’t too bad.  One who had had the IGAP (taken from the lower buttock) mentioned she couldn’t sit down comfortably or wear jeans for quite a few weeks.

Expect to be off your feet for 3-4 days while you are in the hospital and the surgical donor site on your tush heals.

The SGAP scar lies in the upper buttock and is “easily hidden in a French cut bikini or in underwear” (according to The Center for Microsurgical Breast Reconstruction). The IGAP scar lies within the lower buttock crease.

If you choose to have reconstructive surgery, please read my articles Tips For Surgery – Useful Items to Take With You and My Top Favorite Things to Promote Surgery Recovery.

Have you had the GAP surgery?  Perhaps you’d like to comment below on what it was like for you personally so that my readers will have some more good feedback.  Thanks!




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6 thoughts on “Types of Reconstruction Surgery – the GAP flap (incl IGAP, SGAP)

  1. I had a bilateral GAP flap in July 2011. I had no pain and my breasts from the beginning looked symmetrical and natural. I did have an issue with an open incision and a month later had to re-do the right (non-cancer) side, and had a DIEP flap for that side.

    Today, over a year later, you would almost not even know I had a MX and reconstruction. My scars are almost invisable; there is no pain; I look natural.. and at stage II I got a butt lift and lipo to contour the body.

    1. Betsy, thanks for your comment. Sounds like you had a great surgeon and I’m glad the experience was so positive for you (outside of the need for that second surgery). Hope you are well and continue to be so!

  2. I’m currently recovering from IGAP recon surgery. While I have absolutely no pain, and my breasts have healed extremely well, the incision lines along my rear are taking ages. I’m only 25 years old, and other than Breast Cancer, am a completely healthy, active individual. The recovery time is also substantial. I’m about 4 weeks post op, and am basically on bed rest, allowing myself a few walks around the block every day. I have another two weeks of this to go before I can begin bending at the waist again. Be prepared for a long recovery if you opt for IGAP

    1. Hey Rebecca,
      Thanks for adding your personal experience to my page, I’m sure everyone who reads this will appreciate it. You might like to know that there are things that help speed recovery of surgical sites, for instance arnica is an amazing natural healer (see my article http://marnieclark.com/your-breast-surgery-recovery-using-arnica-to-minimize-bruising-and-swelling/ ), also there are certain essential oils that will help reduce pain, swelling and promote healing much more quickly than using nothing. I’m really sorry to learn that you’ve had to go through all of this at your tender age. You might like to sign up for my newsletters (if you haven’t already) as I share a lot of information and special tips on things that put us at a higher risk for breast cancer, as well as things that reduce that risk drastically. You can sign up for them on any page of my website. Wishing you a rapid recovery and disease free future.
      Warmest regards,
      Marnie Clark

  3. I had double SGAP reconstruction in two phases beginning OCT 2015 and completed in DEC 2015. My non radiated breast has healed beautifully, but I am still dealing with some other issues due to non healing incisions on the radiated side. It has just been very slow to fully recover. Fifteen hours of surgery in Oct and 10 hours in Dec took a toll. I’m glad to have my own tissue, but I think I may still need a bit more work to get the radiated side looking right. Numbness on the donor sites exists, but the butt lift was a gift to this 54 year old for going through this journey.

    1. Dear Alana,
      I apologize for the delay in responding to you. So much email these days! Thanks for sharing your experience with us on your reconstruction surgery. If I can help you with healing suggestions on the radiated side, please let me know.
      Warmest regards,
      Marnie Clark

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