TISSUE FROM BUTTOCK
Skin and fat from either upper or lower part of your buttocks can be used to reconstruct the breast. A procedure is called a GAP flap (Gluteal Artery Perforator). Seldom shape and size of the donor area predispose acceptable tissue deficit and a scar on this aesthetically sensitive area.
The firm consistency of gluteal fat due to a developed reticular system makes it hard to create a natural looking breast. Additionally, a demanding flap raising technique puts buttock region on a third place when choosing donor site for autologous breast reconstruction.
GAP flaps tend to make the most sense for women who are having both breasts reconstructed simultaneously but cannot use tissue from the abdomen or inner thigh. Some women might also prefer buttock region as a favourable site for the location of the scar.
General information
Surgery duration: unilateral 4-5 hours, bilateral 6-8 hours
Average hospital stay: 5-7 days
Total recovery time: 4-6 weeks
When would I be able to move about, walk and drive?
Patients should expect to be walking multiple times the day after surgery and can gradually increase walking time and distance as they feel comfortable. By day 5, most patients can head home. Driving shorter distances can generally be resumed after 3 weeks.
When would I be able to exercise again?
After about 6-8 weeks.
Where will the scars be on my body?
About 15-20 cm long horizontal scar on either the upper or lower part of your buttock, in most cases hidden under your underwear. Scars will be present in your breast area as well.
Compression garments and bra?
A compression garment for the donor area must be worn for 4 weeks after the procedure.
Will I need any additional procedures?
Reconstruction is typically finished several months after flap transfer with nipple reconstruction and areola tattooing. In order to achieve the best result sometimes, additional procedures such as liposuction, fat transfer, scar correction, additional procedures for symmetrisation on the other breast might be needed. A significant advantage of autologous reconstruction is the ability to reshape the breast at a later stage to the best final results with a variety of different techniques.
Which are most common technique-related complications?
- Flap necrosis: in rare instances, blood supply through flap vessels is compromised due to thrombosis. The tissue does not receive enough blood and can, if not surgically treated, result in the death of the tissue. The risk is the highest in the first days after the surgery while the patient is still being monitored in a hospital setting.
- Most common donor site problems are aesthetically displeasing scar and tissue deficit resulting in buttock area asymmetry.
How does the procedure look like?
Two possibilities exist, depending on where on your buttock the surgeon takes the tissue. The incision is made either on the upper part of your buttock (SGAP flap) or lower part of your buttock (IGAP flap). The former option is usually preferred, as the latter carries a higher risk of complications.
With an SGAP flap, an oval incision is made along the upper part of your buttock. Skin, fat along with a blood vessel that feeds those tissues are carefully removed and moved to the breast site, where blood vessels are carefully reattached using microsurgery. Tissues are shaped into the shape of the new breast and sewn into appropriate places. The donor area is closed with sutures.
