Where does the tissue come from?
The lower buttock, usually near the buttock crease.
IGAP stands for inferior gluteal artery perforator. These small blood vessels supply the skin and fat used to rebuild the breast.
Breast & Chest · Reconstruction
IGAP Flap Breast Reconstruction
IGAP flap breast reconstruction uses skin and fat from the lower buttock to rebuild a breast without taking the underlying gluteal muscle.
Is it the same as a buttock lift?
No. It is breast reconstruction using transferred tissue.
The donor area is closed after tissue removal, which can change buttock shape. The operation is not designed primarily to lift or enlarge the buttocks.
Who might consider it?
Someone seeking their own-tissue reconstruction when abdominal tissue is unavailable or not preferred.
Suitability depends on donor tissue, blood vessels, health, prior surgery, cancer treatment, and access to a surgeon experienced in microsurgery.
01 · Overview
Understanding IGAP flap reconstruction
An IGAP flap transfers living skin and fat from the lower buttock to the chest. The surgeon disconnects the flap's blood vessels and reconnects them to vessels in the chest under magnification, then shapes the tissue into a breast mound. [1]
Unlike an implant, the flap uses your own tissue. Unlike an SGAP flap, which uses the upper buttock, an IGAP flap uses the lower buttock. The gluteal muscle stays in place, although surgery still affects nearby tissues and leaves a donor-site scar. [1]
Reconstruction may take place with mastectomy or later. Your cancer treatment, available tissue, medical history, and preferences help determine timing. An IGAP flap rebuilds breast shape; it does not treat cancer or reliably restore normal breast sensation. [2]
- Tissue source
- Lower-buttock skin and fat
- Muscle
- Gluteal muscle is preserved
- Surgical method
- Free flap with microsurgical blood-vessel connections
- Recovery setting
- Hospital monitoring followed by recovery at home
Why choose a buttock donor site rather than the abdomen?
Abdominal tissue may be limited, previously used, or unsuitable because of scars or blood-vessel anatomy. Buttock tissue can be an alternative, but its firmness, available volume, donor-site effects, and surgical complexity need careful review.
Can both breasts be reconstructed?
Sometimes. The surgeon must assess tissue and blood vessels on both sides, the desired breast size, and whether reconstruction should be staged. Not everyone has enough suitable tissue for two breast mounds.
02 · Concerns & Goals
What you may want to discuss
Choosing breast reconstruction involves your chest, the tissue donor site, and the recovery you can realistically support. Your priorities help guide the conversation.
Breast shape after mastectomy
You may want a breast mound that fits your frame and feels like part of your body. Available donor tissue limits the size and shape that can be created.
Limited abdominal tissue
Previous abdominal surgery or a lean abdomen may lead you to explore other donor sites. A buttock flap is one option, not an automatic substitute.
Buttock shape and scars
Removing tissue can leave a flatter area, asymmetry, or contour changes. Ask where the scar would sit and how closure may affect the buttock crease.
A demanding recovery
Both the chest and buttock need to heal. Sitting, sleeping, lifting, and caregiving may require adjustments and help at home.
03 · Options
How the approaches differ
These are planning choices within IGAP reconstruction, not interchangeable procedures. Your surgeon can explain which are feasible for you.
Immediate IGAP reconstruction
Reconstruction begins during the mastectomy operation.
How it worksThe breast and reconstructive teams coordinate tissue removal, flap transfer, and shaping during the same surgical session.
May suitSome patients whose health and cancer treatment plans support a combined operation.
Main tradeoffIt involves a lengthy operation, and later radiation or other treatment may affect the reconstructed breast.
Delayed IGAP reconstruction
Reconstruction takes place after mastectomy recovery or other treatment.
How it worksThe flap is transferred in a separate operation, with planning for existing scars and the condition of the chest skin.
May suitPatients who need or prefer more time before reconstruction.
Main tradeoffIt requires another major operation and a period without a reconstructed breast mound.
One-sided IGAP reconstruction
An IGAP flap rebuilds one breast.
How it worksDonor tissue is shaped to relate to the opposite breast, with balancing surgery discussed if appropriate.
May suitPatients reconstructing one breast who have suitable donor tissue and vessels.
Main tradeoffBreast and buttock asymmetry may remain, and additional shaping may be considered.
Two-sided IGAP reconstruction
IGAP tissue may be used to rebuild both breasts.
How it worksThe surgeon evaluates both buttocks and plans whether flap transfers occur together or in stages.
May suitSelected patients needing two breast reconstructions with enough suitable donor tissue.
Main tradeoffBoth donor areas are affected, and operative time, recovery demands, and staging require detailed discussion.
Timing and donor-site choices should be coordinated with your cancer team. Radiation, prior operations, and blood-vessel health can change the plan. [1] [2].
How does IGAP differ from SGAP?
Both are muscle-preserving buttock free flaps. IGAP uses lower-buttock tissue and inferior gluteal perforator vessels; SGAP uses upper-buttock tissue and superior gluteal perforator vessels. Tissue availability, vessel anatomy, scar position, and donor contour help determine the choice.
Will I need an implant as well?
An IGAP flap can provide reconstruction without an implant when enough tissue is available. If the volume is insufficient for your goals, your surgeon may discuss a smaller breast size, another donor site, or a separate augmentation strategy.
04 · Results
What may improve and what may remain
A breast mound made from your tissue
The aim is to restore shape, not recreate an unchanged breast.
- Transferred tissue can provide lasting volume but changes with aging and weight changes.
- Shape and firmness may differ from the other breast.
- Normal sensation is not assured; numbness can persist.
Changes at the donor site
Preserving muscle does not mean the buttock remains unchanged.
- A permanent scar remains near the lower-buttock donor area.
- Flattening, unevenness, or a change in the crease may be noticeable.
- Donor-site discomfort can affect sitting while healing.
Refinement may be staged
The first operation may be one part of reconstruction.
- Swelling and tissue settling make early appearance an incomplete guide to the final shape.
- Later procedures may address contour, symmetry, or scars.
- Nipple reconstruction or tattooing can be discussed separately when appropriate.
Reconstruction outcomes vary with anatomy, healing, cancer treatment, and the procedures included in your plan. [2]
05 · Recovery
Planning your recovery
Recovery at a glance
- Stay after surgery
- Determined by Your Surgeon
- Initial recovery at home
- Varies by Individual
- Return to desk work
- Varies by Procedure and Work Activity
- Light daily activities
- Based on Individual Recovery
- Strenuous exercise
- Based on Surgeon Clearance
Returning to work does not mean fully healed. Follow your surgeon’s instructions; strenuous activity requires clearance.
IGAP recovery involves a newly connected blood supply in the breast and a healing lower-buttock donor site. Your team should provide individualized instructions for positioning, wound care, and activity.
Step 1 · Surgery and immediate monitoring
Treatment day
The operation takes place under general anesthesia. Afterward, the team checks flap circulation closely and manages pain, dressings, and any drains.
Step 2 · The first several days
Hospital recovery
Staff continue flap checks and help you begin movement safely. Discharge depends on circulation, wound progress, mobility, and support at home rather than a fixed date.
Step 3 · The following weeks
Early home recovery
Fatigue, tightness, and discomfort can affect daily routines. Follow the team's specific plan for sitting, sleeping, walking, showering, and drain care.
Step 4 · Over subsequent weeks and months
Gradual return
Activity increases with clearance. Swelling, scars, and sensation continue to change after you feel ready for work; returning to work does not mean healing is complete.
Planning everyday activities
ActivityGeneral planning contextWhat affects the plan
Sitting and sleepingPlanning context: Pressure and tension can affect the lower-buttock incision.What affects it: Ask for a specific positioning plan rather than assuming a cushion or sleeping position is safe.
WalkingPlanning context: Assisted movement usually begins in the hospital. [2]What affects it: Your team sets the pace and distance according to stability, wounds, and clot prevention needs.
Work and drivingPlanning context: Desk work still involves sitting; physical work adds lifting and exertion.What affects it: Timing depends on job demands, donor-site comfort, medication use, and the ability to drive safely.
Exercise and liftingPlanning context: Both chest and donor-site healing matter. [2]What affects it: Resume strenuous activity, lifting, and lower-body workouts only according to your surgeon's clearance.
These are topics to plan with your surgical team, not a universal activity schedule.
Before your procedure
- Review the reconstruction timeline with both your breast surgeon and reconstructive surgeon.
- Share prior operations, radiation, clotting history, medications, supplements, and allergies.
- Ask whether donor-vessel imaging is needed for planning.
- Discuss nicotine use and the team's requirements for stopping before and after surgery.
- Arrange transportation, household help, and support for children or other dependents.
- Get written instructions for medication changes, fasting, hospital arrival, and whom to call after discharge.
Will I have drains?
Drains may be placed in the breast and donor area. If you go home with them, the team should teach you how to care for them and explain when to report changes. Removal depends on your progress, not a universal deadline.
Why are flap checks so frequent?
The transferred tissue depends on its new blood-vessel connections. A circulation problem can threaten the flap and may require urgent surgery. Before discharge, ask what changes you should watch for and how to reach the team immediately.
06 · Safety
Risks and what your clinician assesses
Temporary swelling, bruising, fatigue, tightness, numbness, and discomfort at the chest and buttock are common after major flap surgery. Symptoms should be reviewed if they worsen or differ from what your team told you to expect.
Flap circulation problems
A clot or other blood-flow problem may require urgent surgery. Some or all of the flap can be lost despite treatment.
Bleeding or fluid collections
Blood or fluid can collect at the breast or donor site and may need drainage or another procedure.
Infection or delayed healing
Infection, wound separation, or skin loss can prolong care and may affect the reconstruction or donor-site scar.
Fat necrosis
Areas of transferred fat may lose their blood supply and become firm lumps. Assessment, imaging, or treatment may be needed.
Lasting donor-site or breast changes
Contour differences, asymmetry, noticeable scars, persistent pain, and altered sensation may occur, even with muscle preservation.
Blood clots and anesthesia complications
Major surgery carries risks such as leg or lung clots and heart, lung, or medication-related complications.
Discuss these risks and your individual health history with your surgeon. [2]
What your clinician assesses
- Available lower-buttock tissue, vessel anatomy, scars, and expected donor-site shape
- Chest skin, previous radiation, mastectomy plans, and ongoing cancer treatment
- Nicotine exposure, diabetes, cardiovascular health, and clotting risks
- Reconstruction goals, ability to tolerate a lengthy operation, and recovery support
07 · Costs
What makes up the Total Procedure & Care Cost
Compare written estimates for the same planned scope: one or both breasts, immediate or delayed reconstruction, and any staged procedures. Ask how insurance authorization, network status, and separate bills affect your responsibility.
Surgeon
Surgical care
The planned flap transfer, breast shaping, and donor-site closure.
Ask your surgeonAsk which surgeons bill separately and whether later shaping, balancing surgery, or nipple reconstruction is included.
Facility
Anesthesia and facility
Anesthesia, operating-room services, and the hospital stay.
Ask your surgeonConfirm network status and how an extended stay or additional operation would be billed.
Supplies
Supplies and follow-up
Items such as dressings, prescribed garments, medications, and postoperative appointments.
Ask your surgeonAsk which items and visits are included and which may create separate charges.
TRC
Patient Services
Any separately offered coordination or administrative services.
Ask TRCAsk whether fees apply, what they cover, and whether they are optional or separate from medical care.
Your written estimate should explain the services included, any separate charges, and payment terms.
08 · Questions
Common questions
Is gluteal muscle removed?
An IGAP flap is designed to preserve the gluteal muscle while taking skin, fat, and their supplying perforator vessels. Dissection still affects surrounding tissue, and muscle preservation does not eliminate donor-site symptoms.
Will the reconstructed breast have feeling?
Sensation is often reduced after mastectomy and flap reconstruction. Some feeling may develop over time, but normal sensation is not guaranteed. Ask whether nerve-related techniques are relevant to your case.
Can I have IGAP reconstruction after radiation?
It may be possible, and healthy transferred tissue can be useful in a previously treated chest. Radiation affects planning and healing, so timing and risks need review with your cancer and reconstructive teams.
Does reconstruction change cancer follow-up?
You still need the follow-up recommended by your cancer team. Imaging needs depend on your surgery and remaining breast tissue. Report new lumps, skin changes, or persistent symptoms rather than assuming they are part of reconstruction.
0 consultation questions in your plan
View in My TRC workspaceMy Aesthetic Plan
Prepare for your consultation
Bring these to help your consultation:
- Confirm the donor site, side or sides, timing, and possible backup reconstruction plan.
- Obtain individualized recovery instructions and a round-the-clock surgical contact number.
- Review insurance authorization and a written estimate covering the planned stages.
View My Aesthetic Plan
Choices stay in this visit until saving to your account completes. Nothing is sent to a clinician.
Sources
- [1]American Society of Plastic Surgeons — Breast ReconstructionOwn-tissue breast reconstruction, flap donor-site options including gluteal flaps, microsurgical transfer, and reconstruction planning.
- [2]Mayo Clinic — Breast reconstruction with flap surgeryImmediate and delayed flap reconstruction, donor-site selection, radiation considerations, hospital recovery, activity restrictions, staged refinement, altered sensation, and risks including flap loss, bleeding, infection, and blood clots.
Photographs are illustrative scenes, not patients, staff, facilities or outcomes. This information does not replace a personal assessment by your treating clinician.