Breast Reconstruction Pathways

The IGAP flap (Inferior Gluteal Artery Perforator flap) is a type of natural tissue breast reconstruction that uses skin and fat from the lower buttock area to rebuild the breast. Unlike older techniques, it does not take muscle, which helps preserve strength in the donor site.

This procedure is especially helpful for women who do not have enough abdominal tissue for a DIEP or TRAM flap, or who have had prior abdominal surgery that makes those options less suitable.

How It Works

• A flap of skin, fat, and tiny blood vessels is taken from the lower portion of the buttocks, near where you sit.

• No muscle is removed—the tissue is purely fat and skin.

• Using microsurgery, the surgeon reconnects the blood vessels from the flap to vessels in the chest.

• The flap is then shaped into a new breast mound.

• The donor site is closed, leaving a scar in the crease beneath the buttock, where it is easier to hide.

Who May Be a Candidate

The IGAP flap may be a good option if:

• You prefer reconstruction using your own tissue instead of an implant.

• You don’t have enough abdominal tissue for reconstruction.

• You’ve had previous abdominal surgeries that make abdominal flaps less safe.

• You want a procedure that preserves muscle function at the donor site.

Benefits of the IGAP Flap

• Muscle-sparing: No muscle is taken, reducing risk of weakness in the donor site.

• Natural results: Breasts reconstructed with your own fat and skin look and feel soft and natural.

• Durable: Flap tissue usually lasts a lifetime, unlike implants that may need replacement.

• Body contouring: Removes fat from the lower buttocks, often resulting in a smoother contour.

• Alternative donor site: Expands reconstruction options beyond the abdomen.

Things to Keep in Mind

• Longer surgery: Like other free flap procedures, IGAP requires microsurgery and may take several hours.

• Recovery: Healing usually takes 4–6 weeks, with soreness at both the chest and buttock donor site.

• Scarring: Leaves a scar under the buttock crease, which is generally well hidden.

• Sitting discomfort: Some women experience soreness when sitting during the early healing phase.

• Less tissue volume: May not provide as much tissue as abdominal flaps, sometimes requiring fat grafting for refinements.

Emotional Considerations

Many women who choose the IGAP flap feel relieved to have a natural tissue option even if their abdomen isn’t suitable. The discreet scar placement and preserved muscle strength can be encouraging. At the same time, some women feel nervous about healing in a sensitive area used for sitting. Both feelings are normal—and support can help you through the process.

A Personal Choice

The IGAP flap uses tissue from the lower buttocks—without removing muscle—to rebuild the breast naturally and beautifully. It is a valuable option for women who want natural tissue reconstruction but cannot (or prefer not to) use abdominal tissue. Like all flap procedures, it requires careful planning and recovery, but it can offer beautiful, lasting results.