Septocutaneous Gluteal Artery Perforator Flap in Breast Reconstruction

Abstract

The first free flap breast reconstruction was performed using a myocutaneous flap from the gluteal region. Today, the abdomen is the first choice for the donor site. However, since not all women are eligible to undergo a deep inferior epigastric artery perforator (DIEP) flap, the gluteal region has been re-explored. The myocutaneous free flap underwent multiple technical refinements and modifications since it was first introduced. The most notable modification was the muscle sparing technique that transformed the myocutaneous flap into a perforator flap. In this chapter, the authors explain their technique, based on the superior gluteal artery perforators (S-GAP). Contrary to the original S-GAP flap perforators that run through the muscles (musculocutaneous perforators), the perforators used by the authors run in the septal plane between the gluteus maximus and medius muscles (i.e. septocutaneous perforators). This dissection of the septocutaneous perforators is easier and facilitates the harvest of the septocutaneous gluteal artery perforator (Sc-GAP) flap, compared to the standard S-GAP flap. The surgical technique is described along with several illustrative clinical cases.