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SGAP Overview

Superior Gluteal Artery Perforator Flap

1. Overview

The superior gluteal artery perforator flap utilizes the skin and fat from the upper buttock. This flap relies on the blood vessels that penetrate the gluteus maximus muscle and are named the superior gluteal artery and vein. The flap includes skin and fat but no muscle is taken. The scar resides on the upper part of the buttock in an oblique orientation.

During the procedure, an elliptical portion of skin and fat from the upper buttock is dissected away from all other tissue. Dissection then proceeds towards the superior gluteal artery which is used to give the flap blood flow.

After the flap has been completely dissected it consists of skin, fat and a blood vessel.

The flap is then transferred to the chest wall. The vessels that supply blood to the flap are sewn to the internal mammary artery and vein which lie under the ribs next to the sternum. A small (2cm) portion of the third rib costal cartilage is removed to reveal the underlying vessels. A microscope is used to help the surgeon visualize the vessels so that they can be sewn together.

SGAP Preop

The typical candidate for the SGAP flap surgery is a thin woman with insufficient abdominal tissue for the DIEP flap.

Patients that are not candidates for this type of surgery include:
Patients that smoke
Patients that are professional athletes 
Patients with a BMI > 32. Click here to calculate your BMI.

2. Preoperative Considerations
SGAP Surgery
3. Surgical Considerations

One-sided surgery:
This surgery takes 8 hours. It requires the patient to be in both the supine (lying on the back) and the prone (lying on the front) positions at different times during the operation. Drains are required in the breast as well as the buttock and these are usually removed on post-operative day 10.

Two-sided surgery:
This surgery is not currently performed by Dr Macadam.

SGAP Postop
4. Postoperative Considerations

Patients stay in hospital for 3-5 days and require frequent checks of the flap by the ward nurses to evaluate blood flow. Patients must lie flat for the first two days after surgery to decrease the tension on the incision on the buttock. Flexion of the hips is minimized for the first two weeks following surgery.

Patients are unable to drink caffeine for one month after the surgery and must take aspirin once per day for a month.

Following surgery patients are restricted from exercise or heavy activity for a period of 4 weeks. Patients typically return to work after 4 weeks. Nipple reconstruction is performed 3 months following flap surgery.

SGAP Complications
5. Possible Complications

Wound healing complications (15%)
Mastectomy flap necrosis (15%)
Seroma (15%)
Fat necrosis (10%)
Hematoma (5%)
Total flap failure due to a blood clot (1-2%)
Infection (1-2%)
Hypertrophic scarring (0.5%)
DVT: 0.07 - 3.5%PE: 0.09 - 2%

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