The superior and inferior myocutaneous gluteal
free flaps have been considered as valuable alternatives to the latissimus dorsi or TRAM flap since 1975. The superior gluteal artery perforator (S-GAP) flap is the ultimate refinement of this
myocutaneous flap as no gluteus maximus muscle is harvested. The flap is vascularised by one single perforator originating from the superior gluteal artery. This study summarises the prospectively gathered data on 20 free S-GAP flaps used for
breast reconstruction in 16 patients. Immediate reconstruction was performed in six breasts and delayed in 14 breasts. Mean follow-up was 11.1 months. Two risk factors,
Raynaud's disease and
radiotherapy, were the cause of flap revision in two different patients. Total flap loss occurred in one case. Partial flap loss was not observed and a small area of
fat necrosis was diagnosed by mammography in one other patient. All flaps were anastomosed to the internal mammary vessels at the 3rd costochondral junction. The anatomy of the sensate nerves of the S-GAP flap is described. Two nervous repairs provided early sensory recovery. The free S-GAP flap has become my personal second choice for autologous
breast reconstruction after the
DIEP (deep inferior epigastric
perforator) flap. The S-GAP flap is indicated in patients with an asthenic body habitus or with excessive abdominal
scarring. The advantages are the abundance of adipose tissue in this area even in thin patients, a long vascular pedicle, a hidden
scar, improved projection of the reconstructed breast compared to the
DIEP and TRAM flaps and the preservation of the entire gluteus maximus muscle. The donor morbidity is extremely low.