What is the difference between SGAP and IGAP?
SGAP uses tissue from the upper buttock; IGAP uses tissue from the lower buttock.
The names refer to the superior or inferior gluteal artery perforator blood vessels that supply the tissue.
Reconstructive Surgery
SGAP / IGAP Flap Reconstruction
SGAP and IGAP flap reconstruction rebuild a breast using skin and fat from the buttock while preserving the gluteal muscle.
Is buttock muscle removed?
These flaps are designed to preserve the gluteal muscle.
Skin, fat, and their blood vessels are transferred. Muscle preservation does not eliminate soreness, weakness, or donor-site complications.
Who might consider this approach?
Someone seeking reconstruction with their own tissue when abdominal tissue is unavailable or unsuitable.
A microsurgeon must assess your tissue, blood vessels, medical history, cancer treatment plan, and preferences.
01 · Overview
Breast reconstruction using buttock tissue
SGAP stands for superior gluteal artery perforator, and IGAP stands for inferior gluteal artery perforator. Both are breast reconstruction options that use buttock skin and fat rather than an implant alone. [1]
The surgeon completely separates the flap from its original location and reconnects its blood vessels to vessels in the chest using microsurgery. The tissue is shaped into a breast mound, and the buttock incision is closed. [1]
Unlike a DIEP flap, which uses lower abdominal tissue, these procedures use the buttock. They are also different from cosmetic buttock fat transfer: tissue is moved to reconstruct the breast, not injected to enlarge the buttocks. Reconstruction may begin at mastectomy or later, depending on your treatment plan. [2]
- Donor site
- Upper or lower buttock
- Tissue transferred
- Skin, fat, and blood vessels
- Surgical approach
- Free-flap microsurgery
- Anesthesia
- General anesthesia
Why consider the buttock instead of the abdomen?
You may have limited abdominal tissue, previous surgery that affects available vessels, or a preference for another donor site. Buttock tissue is one alternative, but its shape, volume, and vessels must be suitable.
Can both breasts be reconstructed?
Sometimes. Reconstructing both breasts requires enough suitable tissue and a plan for both donor sites. Your surgeon will explain whether surgery would be performed together or in stages.
02 · Concerns & Goals
What you may want to discuss
Your breast reconstruction goals matter alongside comfort, recovery support, and how you feel about changes to the buttock donor site.
Rebuilding breast shape
You may want a breast mound after mastectomy, with a size and shape that fit your body and available tissue.
Avoiding an implant
You may prefer your own tissue. Whether a flap alone provides your desired volume depends on your anatomy and surgical plan.
Limited abdominal options
Previous operations, limited tissue, or blood-vessel anatomy may make an abdominal flap less suitable.
Buttock shape and comfort
Removing tissue leaves a scar and can change buttock contour. Sitting comfort, clothing fit, and donor-site symmetry deserve discussion before surgery.
03 · Options
How the approaches differ
These are planning choices within SGAP and IGAP reconstruction, not interchangeable procedures. Your microsurgeon can explain which choices your anatomy and cancer care allow.
SGAP flap
Uses skin and fat from the upper buttock.
How it worksThe surgeon isolates perforator blood vessels through the gluteal muscle and reconnects the flap's vessels in the chest.
May suitMay suit someone with adequate upper-buttock tissue and suitable vessels.
Main tradeoffCan leave an upper-buttock scar, flattening, or contour differences; vessel dissection is technically demanding.
IGAP flap
Uses skin and fat from the lower buttock.
How it worksLower-buttock tissue is transferred with its supplying vessels and connected to chest vessels using microsurgery.
May suitMay suit someone whose lower-buttock tissue and blood vessels offer a better donor option.
Main tradeoffThe scar may lie near the buttock crease, and donor-site soreness or contour changes can affect sitting comfort.
Immediate GAP reconstruction
Begins during the same operation as mastectomy.
How it worksThe reconstruction team transfers and shapes the flap after breast tissue removal.
May suitMay suit someone whose cancer treatment plan and overall health allow a combined operation.
Main tradeoffRequires coordination and a lengthy operation; anticipated radiation may influence the recommended timing.
Delayed GAP reconstruction
Rebuilds the breast after mastectomy recovery or other treatment.
How it worksThe flap is transferred during a later operation, with skin replacement tailored to the chest.
May suitMay suit someone who needs more treatment first or wants more time to choose reconstruction.
Main tradeoffRequires a separate major operation, and chest scarring or radiation changes can affect planning.
GAP flaps require specialized microsurgical expertise. Ask about the surgeon's experience with both SGAP and IGAP flaps and the hospital's flap-monitoring and urgent reoperation resources. [1] [2].
Will blood-vessel imaging be needed?
Your surgeon may request imaging to map donor-site blood vessels. The choice depends on your history, anatomy, and the team's planning approach.
How does radiation affect the plan?
Radiation can change skin and tissue quality and may affect reconstructed breast shape. Your plastic surgeon and oncology team should coordinate timing; no single sequence is best for everyone.
04 · Results
What may improve and what may remain
Breast shape and feel
Living tissue can form a breast mound, but it will not recreate the original breast exactly.
- Size and projection depend on available tissue and chest anatomy.
- Some differences between breasts may remain.
- Reconstructed tissue can change with weight and aging.
Sensation and scars
Expect permanent scars and changes in sensation.
- Numbness may affect the breast and buttock donor site.
- Some sensation may return, but normal sensation is not assured.
- Scars usually soften over time but do not disappear.
Further procedures
Reconstruction is often a staged process.
- Later contour adjustments or fat grafting may be discussed.
- Nipple reconstruction or tattooing may be separate choices.
- A procedure on the other breast may improve balance but adds its own risks.
Final appearance takes time to assess as swelling settles and tissues heal. Reconstruction does not replace cancer follow-up. [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.
Recovery involves both the breast and buttock donor site. Your team will tailor positioning, walking, wound care, and activity limits to your flap and healing progress.
Step 1 · Surgery and initial monitoring
Treatment day
After general anesthesia, the team closely checks flap blood flow and manages pain, dressings, and drains.
Step 2 · Usually several days
Hospital recovery
Flap checks continue while staff help you begin moving safely. Discharge depends on flap stability, mobility, pain control, and support at home.
Step 3 · The first several weeks
Early home recovery
Fatigue and soreness can limit daily tasks. Follow your team's specific guidance for sitting, sleeping, drains, and protecting both surgical sites.
Step 4 · Over subsequent weeks and months
Gradual return
Activity increases after examination and clearance. Swelling, scars, sensation, and stamina can continue changing after you return to work.
Planning everyday activities
ActivityGeneral planning contextWhat affects the plan
Sitting and sleepingPlanning context: Donor-site pressure and incision tension matter, especially after an IGAP flap.What affects it: Ask for specific positions, sitting limits, and support recommendations before discharge.
Work and household tasksPlanning context: Plan for several weeks away, with longer restrictions possible for physical work. [2]What affects it: Desk work still involves sitting and fatigue; returning to work does not mean complete healing.
DrivingPlanning context: Resume only after your team clears you and sedating medicines are no longer needed.What affects it: You must be able to sit comfortably, turn, and brake safely.
Exercise and liftingPlanning context: Early assisted walking differs from strenuous exercise. [2]What affects it: Your surgeon will set lifting and workout limits based on both sites and any complications.
Use your surgical team's instructions rather than a general recovery timeline, especially if another procedure is performed at the same time.
Before your procedure
- Review previous breast, abdominal, and buttock operations with your microsurgeon.
- Coordinate reconstruction timing with your oncology team, including any planned radiation.
- Share all medicines, supplements, allergies, and any history of blood clots.
- Discuss nicotine use and the team's requirements for stopping before and after surgery.
- Arrange transportation and help with meals, children, pets, and daily tasks.
- Ask for a personalized plan for positioning, wound care, follow-up, and urgent contact.
Will I go home with drains?
You may have drains at the breast and donor site. Your team should teach you how to care for them and explain when to call. Removal depends on drainage and healing rather than a fixed date.
What if sitting is uncomfortable?
Tell your team rather than improvising a pressure-relief device or position. They can recommend ways to protect the incision without putting harmful pressure elsewhere.
06 · Safety
Risks and what your clinician assesses
Swelling, bruising, fatigue, tightness, temporary difficulty moving comfortably, and altered sensation are common early experiences. Symptoms should generally improve; new or worsening changes need assessment.
Blood-flow problems or flap loss
A clot or circulation problem can threaten part or all of the flap. Urgent surgery may be needed, and the flap may not survive.
Bleeding or fluid collection
Blood or fluid can collect at either surgical site and may require drainage or another operation.
Infection or delayed healing
Infection, wound separation, or skin loss can prolong recovery and require additional treatment.
Fat necrosis or firmness
Areas of transferred fat can lose their blood supply and become firm or form lumps. New lumps should be assessed rather than assumed to be harmless.
Donor-site and appearance changes
Buttock flattening, uneven contours, persistent pain, numbness, noticeable scars, or breast asymmetry may remain.
Anesthesia and blood-clot complications
Major surgery carries risks including anesthesia reactions and clots in the legs or lungs. Your team will assess and reduce these risks where possible.
Discuss these risks and your individual health history with your surgeon. [3]
What your clinician assesses
- Available buttock tissue, vessel anatomy, and donor-site scar placement
- Chest skin, previous reconstruction, and radiation history or plans
- Heart and lung health, diabetes, nicotine exposure, and clotting history
- Recovery support, mobility needs, goals, and willingness to undergo staged surgery
07 · Costs
What makes up the Total Procedure & Care Cost
Compare written estimates for the same planned scope, including one or both breasts, donor-site surgery, hospital care, and any later stages. Ask your insurer about coverage, authorization, and network requirements.
Surgeon
Surgical care
Surgeon services for flap transfer, microsurgery, breast shaping, and donor-site closure.
Ask your surgeonAsk whether assistant surgeons, later revisions, or nipple reconstruction are billed separately.
Facility
Anesthesia and facility
Anesthesia, operating room services, hospital stay, and postoperative monitoring.
Ask your surgeonConfirm network status and how an extended stay or unplanned operation would be billed.
Supplies
Supplies and follow-up
Potential charges for dressings, prescribed garments, medicines, and follow-up visits.
Ask your surgeonAsk which items and visits are included and whether rehabilitation has separate costs.
TRC
Patient Services
Any separately described administrative or care-coordination services.
Ask TRCAsk whether these services carry a fee, are optional, or are covered by insurance.
Your written estimate should explain the services included, any separate charges, and payment terms.
08 · Questions
Common questions
Is this the same as a buttock lift?
No. SGAP and IGAP surgery remove selected buttock tissue to reconstruct a breast. Although buttock contour changes, the purpose and surgical plan differ from a cosmetic buttock lift.
Will I need an implant too?
Not necessarily. These flaps can provide breast volume without an implant, but available tissue may limit size. Your surgeon can discuss whether additional procedures would help meet your goals.
Can I have this after an implant reconstruction?
Sometimes. A GAP flap may be considered when replacing an implant reconstruction, but chest vessels, scarring, prior radiation, and donor tissue need careful assessment.
Does reconstruction affect cancer monitoring?
You still need the follow-up recommended by your oncology team. Screening and imaging depend on the surgery performed and any remaining breast tissue. Report new lumps or skin changes promptly.
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 flap type, donor side, breast goals, and planned timing.
- Get a personalized recovery plan and reliable help at home.
- Review the written estimate, insurance requirements, and urgent contact information.
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 Reconstruction — Flap ProceduresUse of donor tissue for breast reconstruction, gluteal flap options, muscle-preserving perforator approaches, and microsurgical tissue transfer.
- [2]Mayo Clinic: Breast Reconstruction with Flap SurgeryDonor-site choices, immediate and delayed timing, radiation considerations, alternatives, recovery over weeks, sensation changes, and staged reconstruction.
- [3]American Society of Plastic Surgeons: Breast Reconstruction — Safety and RisksBleeding, infection, healing problems, flap loss, fat necrosis, sensation changes, anesthesia and clot risks, and urgent evaluation of shortness of breath or chest pain.
Photographs are illustrative scenes, not patients, staff, facilities or outcomes. This information does not replace a personal assessment by your treating clinician.