What does SGAP mean?
Superior gluteal artery perforator.
These small blood vessels supply the upper-buttock skin and fat used to form the breast.
Breast & Chest · Reconstruction
SGAP Flap Breast Reconstruction
SGAP flap breast reconstruction uses skin and fat from the upper buttock to rebuild a breast while preserving the gluteal muscle.
Is an implant required?
Not usually.
The flap provides the breast volume, but available tissue and your goals determine whether additional procedures are considered.
Is this major surgery?
Yes—SGAP is microsurgical reconstruction.
It requires general anesthesia, a hospital stay and recovery at both the chest and buttock.
01 · Overview
Understanding SGAP reconstruction
SGAP reconstruction moves living tissue from the upper buttock to the chest. The surgeon separates the flap from its original blood supply, shapes it into a breast and connects its small blood vessels to vessels in the chest using microsurgery. [1]
This may be an option when abdominal tissue is limited, previous surgery affects other donor sites or you prefer to discuss a non-abdominal flap. A surgeon must assess the upper-buttock tissue and blood vessels, your health and the size of breast you hope to rebuild. [1]
SGAP is different from an IGAP flap, which uses the lower buttock, and a DIEP flap, which uses the lower abdomen. It reconstructs breast shape after mastectomy; it does not treat cancer or reliably restore normal breast sensation. [1]
- Donor area
- Upper buttock
- Tissue used
- Skin and fat with their blood vessels
- Muscle
- Gluteal muscle is preserved
- Procedure type
- Free-flap microsurgery
Why does preserving muscle matter?
An SGAP flap takes skin and fat without removing the gluteal muscle. This avoids sacrificing that muscle, although pain, tightness, contour changes and temporary movement limitations can still occur.
Can it be done at the time of mastectomy?
Sometimes. Immediate or delayed reconstruction depends on your cancer treatment, health, donor tissue and access to a team experienced in SGAP microsurgery. Radiation plans are especially important to discuss.
02 · Concerns & Goals
What you may want to discuss
Your reconstruction choices depend on your health, available tissue, cancer treatment and what matters most to you.
Rebuilding breast shape
You may want a breast mound made from your own tissue rather than an implant. The amount of usable buttock tissue affects the size that can be created.
Limited abdominal tissue
A thin abdomen or certain prior operations may lead you to explore other donor areas. These factors do not automatically make SGAP the best choice.
Buttock scars and contour
Removing tissue leaves a scar and can change upper-buttock fullness or symmetry. Ask where the scar would sit in your usual clothing.
A demanding recovery
Both the chest and donor area need time to heal. Planning help with transportation, meals, children and daily tasks can make recovery more manageable.
03 · Options
How the approaches differ
These are planning choices within SGAP reconstruction, not interchangeable treatments. Your surgeon can explain which are realistic for you.
Immediate SGAP reconstruction
Reconstruction begins during the same operation as mastectomy.
How it worksThe microsurgical team transfers upper-buttock tissue after breast removal.
May suitPeople whose cancer treatment and overall health allow a combined operation.
Main tradeoffIt is a lengthy operation, and later radiation or healing issues may affect the reconstructed breast.
Delayed SGAP reconstruction
Reconstruction happens after mastectomy recovery or other treatment.
How it worksThe surgeon rebuilds the breast in a separate operation.
May suitPeople who need or prefer more time before reconstruction.
Main tradeoffIt involves another major operation, and chest scarring or prior radiation can affect planning.
One-sided SGAP reconstruction
A flap rebuilds one breast.
How it worksUpper-buttock tissue is shaped to work with the remaining breast.
May suitPeople seeking reconstruction after a one-sided mastectomy.
Main tradeoffPerfect matching is unlikely; breast balancing or donor-site contour procedures may be discussed.
Two-sided SGAP reconstruction
Separate flaps rebuild both breasts.
How it worksTissue is typically taken from both upper buttocks, in one operation or staged procedures.
May suitSelected people with enough donor tissue and suitable blood vessels for both sides.
Main tradeoffSurgery and recovery are more extensive, with donor wounds on both sides.
Flap selection and reconstruction timing should be coordinated with your breast surgeon, oncology team and reconstructive microsurgeon. [1] [2].
How is the donor tissue evaluated?
Your surgeon examines tissue volume, scars and circulation. Blood-vessel imaging may be requested to help locate suitable perforators and plan the transfer.
Does every reconstruction surgeon offer SGAP?
No. SGAP requires specialized microsurgical experience. Ask how often the team performs it, where recovery monitoring happens and how urgent flap problems are managed.
04 · Results
What may improve and what may remain
Breast shape and feel
Your own tissue can create a breast mound, but it will not be identical to the original breast.
- Size depends partly on available donor tissue.
- Sensation is often reduced and may remain different permanently.
- Nipple reconstruction or tattooing may be separate choices.
Changes at the donor site
The upper buttock will have a scar and a different contour.
- A depression, asymmetry or tightness may remain.
- Preserving muscle does not eliminate donor-site discomfort.
- Scars usually soften over time but do not disappear.
A staged process
The first operation may not be the last step.
- Swelling and shape evolve over months.
- Fat grafting or other adjustments may help address contour differences.
- Weight changes and aging can change the reconstructed breast.
Reconstruction does not replace cancer follow-up. Ask your oncology team how surveillance will be managed after your specific surgery. [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 two surgical areas and early monitoring of the flap's circulation. Your team's instructions should guide activity, positioning and wound care.
Step 1 · Day of surgery
Treatment day
After general anesthesia and microsurgery, staff closely check the flap's blood supply. You may have drains at the breast and donor site.
Step 2 · The first several days
Hospital recovery
The team monitors circulation, manages pain and helps you begin safe movement. Discharge depends on flap stability and your ability to manage daily needs.
Step 3 · The following weeks
Early recovery at home
Fatigue, swelling and soreness can affect walking, sitting and reaching. Follow-up visits check the wounds and guide drain removal and activity changes.
Step 4 · Over weeks to months
Gradual return
Strength and endurance return gradually. Scars and breast contour continue changing after you resume some normal activities; returning to work is not the same as complete healing.
Planning everyday activities
ActivityGeneral planning contextWhat affects the plan
Sitting and sleepingPlanning context: Pressure and positioning need individual guidance.What affects it: Ask how to protect the upper-buttock incision and chest without placing prolonged pressure on healing areas.
Walking and exercisePlanning context: Gentle movement usually starts with assistance. [3]What affects it: Your team sets limits for lifting, bending, strenuous exercise and activities that pull on either surgical site.
Work and household tasksPlanning context: Many people need several weeks away from work. [3]What affects it: Physical jobs, prolonged sitting, fatigue and complications may extend the time needed. Arrange help with heavier tasks.
DrivingPlanning context: Resume only when cleared and able to drive safely.What affects it: You need to be off impairing pain medicine and able to sit, turn, wear a seat belt and brake suddenly without limitation.
Ask for instructions tailored to an upper-buttock donor site rather than relying on an abdominal-flap recovery guide.
Before your procedure
- Review reconstruction timing with your cancer care team.
- Share prior operations, radiation treatment and any clotting or healing problems.
- Review all medicines, supplements and hormones; change them only as directed.
- Discuss nicotine use and the team's requirements for stopping before and after surgery.
- Arrange transportation and help at home for both chest and buttock recovery.
- Get written guidance on fasting, hospital needs, drains and after-hours contact.
Will I need special dressings or garments?
Possibly. Your team will decide what support or dressings are appropriate and how to avoid pressure on the flap and donor site. Do not add compression garments without checking first.
How are drains managed?
If drains are used, staff will teach you how to care for them and record output. Removal depends on drainage and healing rather than a fixed date.
06 · Safety
Risks and what your clinician assesses
Temporary swelling, bruising, fatigue, soreness and altered sensation are common. Symptoms should generally improve; sudden changes or worsening pain need assessment.
Blood-supply problems or flap loss
A clot or circulation problem can damage part or all of the flap. Urgent surgery may be needed, and the flap cannot always be saved.
Bleeding or fluid collection
Blood or clear fluid can collect at either surgical site and may require drainage or another procedure.
Infection or delayed healing
Wounds may become infected, separate or heal slowly, sometimes requiring medicines, dressings or additional surgery.
Fat necrosis and contour differences
Some transferred fat may not survive, causing firm areas or lumps. Breast or buttock unevenness may need evaluation or revision.
Persistent donor-site symptoms
Buttock discomfort, numbness, noticeable scars or contour changes may persist. Breast sensation may also remain reduced.
Clots and anesthesia complications
Major surgery carries risks including blood clots in the legs or lungs, breathing problems and reactions to anesthesia.
Discuss these risks and your individual health history with your surgeon. [4]
What your clinician assesses
- Available upper-buttock tissue, vessel anatomy and prior donor-site surgery
- Heart and lung health, diabetes, nutrition and ability to tolerate a long operation
- Nicotine exposure, circulation, clotting history and medicines
- Radiation plans, breast goals and support during recovery
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 surgery, donor-site care and any later stages. Ask how insurance authorization and out-of-pocket costs apply to your plan.
Surgeon
Surgical care
Reconstructive surgeon services, microsurgery and any planned breast-balancing procedures.
Ask your surgeonAsk whether later revisions, fat grafting or nipple reconstruction are separate.
Facility
Anesthesia and facility
Anesthesia, operating room services, hospital admission and flap monitoring.
Ask your surgeonConfirm network status and how an extended stay or return to surgery would be billed.
Supplies
Supplies and follow-up
Dressings, prescribed garments, medicines and postoperative visits.
Ask your surgeonAsk which items and visits are included and whether imaging or rehabilitation is billed separately.
TRC
Patient Services
Any separately listed education, scheduling or care-coordination services.
Ask TRCAsk what each service includes, whether it is optional and whether insurance covers it.
Your written estimate should explain the services included, any separate charges, and payment terms.
08 · Questions
Common questions
Is SGAP a buttock implant procedure?
No. It removes upper-buttock skin and fat to reconstruct the breast. It does not enlarge the buttock and can reduce fullness where tissue is taken.
Can I choose SGAP even if I have abdominal tissue?
You can discuss it, but the choice depends on vessel anatomy, tissue volume, donor-site tradeoffs and your surgeon's assessment. It is not automatically preferable to an abdominal flap.
Will the reconstructed breast feel normal?
It may feel soft because it contains your own tissue, but sensation is commonly reduced. Normal sensation cannot be promised.
What if the flap does not survive?
Your team may attempt urgent surgery to restore circulation. If the flap cannot be saved, damaged tissue may need removal, followed by discussion of another reconstruction approach after recovery.
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, breast side or sides, timing and possible later stages.
- Arrange recovery support and obtain individualized activity and wound-care instructions.
- Review the written estimate, insurance details and urgent contact plan.
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 ReconstructionOverview of breast reconstruction, tissue-flap approaches, donor-site considerations and differences between reconstruction methods.
- [2]MedlinePlus: Breast ReconstructionReconstruction timing, implant and tissue-based choices, alternatives to reconstruction and coordination with cancer care.
- [3]American Society of Plastic Surgeons: Breast Reconstruction RecoveryIndividualized recovery instructions, dressings and support garments, drains, follow-up and activity restrictions.
- [4]American Society of Plastic Surgeons: Breast Reconstruction Risks and SafetyBleeding, infection, healing problems, flap loss, fat necrosis, sensation changes, anesthesia risks and urgent assessment for chest pain or shortness of breath.
Photographs are illustrative scenes, not patients, staff, facilities or outcomes. This information does not replace a personal assessment by your treating clinician.