Breast Reconstruction Pathways

The Superior Gluteal Artery Perforator (SGAP) flap is a type of natural tissue breast reconstruction that uses skin and fat from the upper buttock area to rebuild the breast. Like the IGAP flap, it does not take muscle, which helps preserve strength and function at the donor site.

This option is especially helpful for women who don’t have enough abdominal tissue for reconstruction, or who’ve had prior abdominal surgery that rules out options like DIEP or TRAM flaps.

How It Works

• A flap of skin, fat, and blood vessels is taken from the upper portion of the buttocks.

• No muscle is removed—the flap relies only on fat, skin, and tiny blood vessels.

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

• The tissue is carefully shaped into a new breast mound.

• The donor site is closed, leaving a scar across the upper buttock, usually hidden under underwear or swimwear.

Who May Be a Candidate

The SGAP flap may be a good choice if:

• You prefer natural tissue reconstruction instead of implants.

• You don’t have enough abdominal tissue for a DIEP or TRAM flap.

• You’ve had previous abdominal surgery that makes those options less safe.

• You want to preserve muscle strength while using your own fat and skin.

Benefits of the SGAP Flap

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

• Natural results: Uses your own fat and skin, which look and feel soft and natural.

• Long-lasting: Unlike implants, flap tissue usually lasts for life.

• Hidden scar: Donor scar is placed across the upper buttock and can be concealed by clothing.

• Alternative donor site: Expands reconstruction options for women who cannot use abdominal tissue.

Things to Keep in Mind

• Complex microsurgery: SGAP flaps require advanced surgical expertise and longer surgery time.

• Recovery: Healing takes about 4–6 weeks, with soreness at both the breast and buttock donor sites.

• Scarring: Scar runs across the upper buttock but is usually hidden under clothing.

• Sitting discomfort: Some women experience temporary soreness when sitting or lying down.

• Volume limits: May not provide as much tissue as abdominal flaps, so some women may need fat grafting later.

Emotional Considerations

Many women who choose the SGAP flap feel reassured that they have a natural tissue option even if their abdomen isn’t available. The preserved muscle strength and hidden scar can be comforting. Others may feel hesitant about healing in such a sensitive area. Both reactions are normal—and support from your care team can help ease concerns.

A Personal Choice

The SGAP flap uses tissue from the upper buttocks—without removing muscle—to naturally rebuild the breast with lasting results. It is a valuable alternative for women who want natural tissue reconstruction but cannot or prefer not to use abdominal tissue. While it involves a longer, more complex surgery, it can create beautiful, lasting results with no muscle sacrifice.