SGAP Flap Procedure
There are several means of reconstructing the breast after mastectomy or after other breast trauma, including birth defect. Some women opt for artificial implants composed of silicone or saline, but some women opt to use donor tissue from their own bodies because it can produce a more natural looking and feeling breast. The site of that donor tissue depends on the end result desired by the patient and the unique anatomy of that patient. For patients who do not have enough abdominal tissue for an effective DIEP flap, a technique called a Superior Gluteal Artery Perforator (SGAP) flap is often used instead.
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What Happens During a SGAP Flap Procedure?
During your SGAP procedure, your plastic surgeon will make an incision on your upper buttock area, just beneath your back, and generally in an area that will be hidden by your underwear. Tissue—including muscle tissue and blood vessels—will be removed from your upper buttock area and implanted into your chest area, usually into the pocket formed by a tissue expander. The surgeons at ECAPS will then use microsurgery techniques to effectively graft the donor blood vessels into your chest.
Whereas some flap procedures leave an indent where the muscle tissue is removed, that isn’t necessarily the case with SGAP flap procedures, which generally do not interfere with the contours of the buttocks. That said, sometimes the procedure can tighten the skin around the area, performing a kind of lower body lift—incidentally making the area look a little more youthful. SGAP flap procedures also offer the benefit of reconstructing the breast entirely out of your body’s own tissues, as there are generally ample donor materials available from this area of the body. This means the breast looks and feels quite natural, especially compared to saline or silicone implants.
Am I a Good Candidate for an SGAP Flap Procedure?
Because all patients have unique goals and individual needs, SGAP flap procedures are not right for everyone. However, if you exhibit the following characteristics, an SGAP Flap procedure might be a good fit:
- You are in generally good physical condition and can withstand the stresses of major surgery
- You have undergone or are planning to undergo a mastectomy
- Your breasts have been damaged or are missing due to lumpectomy, radiation, injury, or birth defect
- Your breast abnormality or trauma causes you to feel less feminine or simply makes you unhappy or unsatisfied
- Your abdominal muscles have been eliminated as a potential donor site
- You are not having radiation treatments directed at your upper arm or chest area, or your oncologists has determined reconstruction will not interfere with these treatments
Upon consulting about your end goals and desired final look, the plastic surgeons at East Coast Advanced Plastic Surgery will help you determine the most appropriate course of action. Many of our New Jersey SGAP Flap patients pursue reconstruction immediately, while others delay—much depends on the personal circumstances of the patient. To optimize the chances of meeting your expectations, you should come prepared to discuss your entire medical history, including any tobacco, alcohol, and illegal drug use. You should also be prepared to discuss recent medical treatments, prior procedures, and any medications you’re taking, among other information. This will help the plastic surgeons at ECAPS determine the best course of action to achieve your results.
Special Considerations for a SGAP Flap Procedure
Every patient is unique, especially when it comes to a procedure such as breast reconstruction. Still there are some considerations that the surgeons at ECAPS must almost universally take into consideration.
- Age: While age isn’t in itself a factor, the development of the breast may be. Even for breast reconstruction because of cancer, it’s usually best to wait until the breast tissue has finished developing. However, this does not automatically negate eligibility.
- Cancer Treatment: Ongoing cancer treatments can affect the optimal timing of certain procedures, and can dictate which procedures are performed at which time. Your ECAPS plastic surgeon will ask to discuss your plastic surgery with your breast surgeon or oncologist to ensure that your plastic surgery does not affect any ongoing treatment. At times, multiple procedures may be necessary for optimal reconstruction outcomes.
- Pregnancy: Pregnancy can cause bodily changes, which can affect the long-term results of your surgery, so it’s important to tell us if you are pregnant or if you plan on having children in the near future. Your ECAPS surgeon may have special instructions on how to care for your results.
Review from D.Z. | Source: Healthgrades | Oct 3, 2019
“Dr Chalfoun and his staff are amazing. I had a bilateral mastectomy last year with reconstruction. I just came from my permanent implant post op visit today. I cannot express the amount of gratitude I have for him and his staff. His bedside manner is nothing compared to his expertise and commitment to breast cancer patients. All I had to concern myself with was fighting cancer. They took care of everything else. I am blessed he was part of this difficult experience. I almost chose to decline the reconstruction because all I cared about was getting the cancer out. I was referred to his office for a consultation through my breast surgeon. He made me feel at ease and helped me to make an informed decision. Now I am grateful I made the decision to get the reconstruction done. I may not have my own breasts but thanks to the doc I feel like myself again.”
Surgery and Recovery
Any SGAP flap procedure will likely be performed in a hospital setting using general anesthesia. After the surgery is performed, you can count on staying in the hospital for the following three or four days, though you should be mobile by the forth day, though perhaps not comfortably so. You may have surgical drains inserted around your incisions to help keep swelling under control and decrease the associated pain. These tubes may be removed after a week or so if drainage has sufficiently slowed.
After four to six weeks, you should be able to resume most of your normal activities, though it would be wise to avoid anything too strenuous for the next few months. You may also want to consider wearing loose fitting clothing during those initial six weeks, as tight-fitting jeans have the potential to irritate your healing incision and cause quite a bit of pain. The plastic surgeons at East Coast Advanced Plastic Surgery will provide you with detailed recovery instructions both to safeguard your results and to minimize your pain. It’s important that you follow those directions and check in regularly at scheduled follow-ups.