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GAP Flap, Other Free Flaps

Some patients will choose autogenous tissue reconstruction over implants, but will not have a sufficient abdominal donor site to create a breast mound. This could be due to a slender body shape, previous surgery of the abdomen, or failure of a previous abdominal flap. Although they are rarely indicated, there are a number of alternative flaps which have been used successfully for breast reconstruction.

The most common alternate flap choice is the gluteal artery perforator (GAP) free flap using skin and fat from the buttocks. This procedure utilizes either the superior or inferior gluteal vessels, but without having to harvest any of the gluteus maximus muscle. Instead, blood supply is provided through the perforator vessels that are teased out from the gluteus muscle, using a muscle incision alone. The surgeon will apply judgment in the operating room to determine how many perforators are needed to provide sufficient blood supply for the flap to survive. This flap can be harvested from one buttock, with a well hidden scar, or can be harvested from both buttocks for bilateral breast reconstruction. Flap elevation is completed while the patient is sleeping face down, and then the patient is turned over to allow the flap to be attached to the chest with the microscope. A significant disadvantage to this type of reconstruction is that it is technically more difficult to perform. Also, the tissue from the buttock is somewhat harder to shape into a breast.

GAP Free Flap Reconstruction

GAP Free Flap Reconstruction

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Even less commonly utilized flaps include the Rubens free flap, taken from the patient’s flank, and the lateral transverse thigh free flap, taken from the outer thigh. These techniques, among a small handful of others, have specific advantages and applications; however, since they are so rarely utilized, they will not be described in further detail here. If you do not have sufficient abdominal skin and fat to create a breast shape, and if you do not want or cannot have implant reconstruction, you can inquire with your plastic surgeon about these alternative flap options.

Please go to our Personal Stories section to see before and after photos.