Gluteal Flap Breast Reconstruction (SGAP & IGAP): 3D Animation, Step-by-Step Guide & Recovery
- Dr. Mahyar Foumani
- Apr 25
- 5 min read
Updated: 3 days ago
Gluteal flap breast reconstruction uses tissue from the buttock to rebuild a breast after mastectomy. There are two main types. The SGAP flap (Superior Gluteal Artery Perforator) takes tissue from the upper buttock. The IGAP flap (Inferior Gluteal Artery Perforator) takes tissue from the lower buttock crease. Both use microsurgery and last 5 to 8 hours. Both keep all buttock muscle in place. They make a soft, natural breast. Gluteal flaps are a good option when belly tissue (DIEP flap) cannot be used. This may be due to past surgery or too little belly tissue.
Watch a 3D animation of gluteal flap breast reconstruction
The animation below shows the surgery step by step. It shows how skin and fat are taken from the buttock with their feeding blood vessels. It shows the tissue being moved to the chest. It also shows the blood vessels being reconnected under a microscope to form a new breast.
How does gluteal flap breast reconstruction work?
The surgery has 5 main steps. It takes 5 to 8 hours per breast. You are turned during the surgery. You lie on your side to take the flap. You then lie on your back to reconnect the vessels and shape the breast.
Imaging before surgery. A CT scan maps the small feeding blood vessels in the buttock. This helps the surgeon pick the best vessels for the flap.
Positioning. You are placed on your side so the surgeon can reach the buttock.
Taking the flap. Skin and fat are freed from the upper buttock (SGAP) or the lower buttock crease (IGAP). They are taken with their feeding vessels. The buttock muscles stay fully in place.
Reconnecting the blood vessels. You are turned onto your back. The flap vessels are joined to vessels in the chest. These are usually vessels behind the breastbone (internal mammary) or near the armpit (thoracodorsal). The work is done under an operating microscope.
Shaping the breast and closing the donor site. The surgeon shapes the tissue into a new breast. The buttock is then closed in layers. This often improves the local shape as a bonus.
SGAP versus IGAP: which gluteal flap is right for you?
SGAP and IGAP differ mainly in two things: where the tissue is taken and where the scar sits. The choice depends on your body shape, your scar preference, and how much sitting discomfort you can accept during recovery.
SGAP flap (Superior Gluteal Artery Perforator)
The SGAP flap takes skin and fat from the upper buttock. It keeps all buttock muscle in place. The blood vessels are reconnected with microsurgery. The result is a natural breast. The fat feels much like natural breast tissue. The scar sits on the upper buttock. SGAP suits women with enough upper-buttock volume who do not have enough belly tissue for a DIEP flap.
IGAP flap (Inferior Gluteal Artery Perforator)
The IGAP flap takes skin and fat from the lower buttock crease. The scar hides well in the crease. This looks better than the SGAP scar. But sitting is harder during early recovery. IGAP also carries a small risk of irritating the sciatic nerve (the large nerve that runs down the leg), because this nerve is close to the surgical area. IGAP suits women with full lower buttocks who want a hidden scar.
What are the advantages of gluteal flap breast reconstruction?
Another donor site. It gives an option to women with past belly surgery, too little belly tissue, or reasons they cannot have a DIEP flap.
Natural tissue. Buttock fat feels much like breast tissue. This allows good shaping and natural movement.
Full muscle preservation. Only skin, fat, and feeding vessels are taken. Buttock function for walking and climbing stays fully intact.
Long-term stability. Like other own-tissue methods, gluteal flaps are permanent. They never need replacing, unlike implants.
Bonus shaping. Some women like the improved buttock shape after the donor site is closed. It is a bit like a buttock lift.
Considerations and limitations of gluteal flap reconstruction
A gluteal flap is harder to do than a DIEP flap. It is only done at specialised microsurgery centres. The surgery takes 5 to 8 hours per breast. This is because the vessel work is detailed and you must be turned during surgery. Donor site discomfort during sitting is the most noticeable part of recovery. It usually improves a lot by week 8 to 12.
A scar on the buttock stays after healing. IGAP scars usually hide better in the crease than SGAP scars on the upper buttock. But IGAP carries a small risk of sciatic nerve irritation. The tissue volume is sometimes limited. Women who want a larger breast may not have enough buttock tissue.
Who is a good candidate for gluteal flap reconstruction?
Good candidates have too little belly tissue or past belly surgery, such as a tummy tuck or large liposuction. This rules out a DIEP flap. They have enough buttock volume. They do not smoke and are in good general health. They accept the longer surgery and the sitting discomfort during early recovery. In return, they get a permanent, natural reconstruction.
What is recovery after gluteal flap surgery like?
You stay in hospital for about 5 to 7 days. The first 2 to 3 weeks at home bring sitting discomfort and limited movement. Surgical drains stay in both sites for 1 to 2 weeks. Special cushions help you sit more comfortably. Most women return to light work in 6 to 8 weeks. Most reach full activity by 12 to 16 weeks. The final look develops over 6 to 12 months as swelling settles.
Patient story
"Because of previous abdominal surgeries, I was not a candidate for DIEP flap. My surgeon recommended an SGAP flap using tissue from my upper buttock. The procedure took about 6 hours. The recovery was challenging but manageable. The buttock donor site was uncomfortable for sitting during the first few weeks, but this improved significantly by month 2. Now, 15 months later, my reconstructed breast looks and feels remarkably natural, and the buttock scar has faded somewhat." — Emma, unilateral SGAP flap reconstruction
Frequently Asked Questions About Gluteal Flap Breast Reconstruction
Where to find gluteal flap breast reconstruction videos online?
Free 3D animation videos of gluteal flap surgery (SGAP and IGAP) are on breastreconstructionsurgeon.com. This is the educational platform by Dr. Mahyar Foumani. The animations show the flap being taken, the vessels being reconnected, and the breast being shaped. More surgical animations of all major techniques are on the YouTube channel @Breastreconstruction.
How long does gluteal flap surgery take?
It takes 5 to 8 hours per breast. Reconstruction of both breasts is usually done in two stages. This is because you must be turned during the surgery.
What is the difference between SGAP and IGAP flap?
SGAP takes tissue from the upper buttock. The scar sits on the upper buttock. IGAP takes tissue from the lower buttock crease, where the scar hides better. But with IGAP, sitting is harder during recovery. There is also a small risk of sciatic nerve irritation.
How painful is sitting after a gluteal flap?
Sitting discomfort is the most noticeable part of recovery. The first 2 to 3 weeks are the hardest. Special cushions help. Most women feel a clear improvement by week 8. Most have full relief by 3 months.
Does a gluteal flap affect walking or running?
No. Both SGAP and IGAP keep all buttock muscle in place. Long-term function for walking, climbing, running, and other activities stays fully intact.
Is gluteal flap reconstruction permanent?
Yes. The moved tissue becomes part of your body. It ages naturally and never needs replacing. Breast implants, by contrast, usually last 10 to 20 years.
Written by Dr. Mahyar Foumani, plastic and reconstructive surgeon. Based on the book 'Breast Reconstruction Explained' (ISBN 978-9083545189). For more information and surgical animations, visit breastreconstructionsurgeon.com.
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