GAP Flap | Other Free Flaps – Newport Beach | Orange County
A number of patients who choose autogenous tissue reconstruction instead of implants do so because they do not have sufficient abdominal tissue at the donor site. This could be for many different reasons including a slender body shape, previous abdominal surgery, or failure of an abdominal flap previously. Although rarely chosen, there are a number of alternative flaps that had been used successfully in breast reconstruction.
The most common alternative flap choice is called the gluteal artery perforator (GAP) flap. This method uses skin and fat from the buttocks. This procedure uses either the superior or inferior gluteal vessels, but without harvesting any of the gluteus maximus muscle. Alternatively, blood supply is maintained through the perforator vessels that are teased out from the gluteus muscle, solely utilizing the muscle incision. Dr. Seify will use his judgment in the operating room to determine the number of perforators needed to maintain sufficient blood supply in order for the flap to survive. The flap can be harvested from one buttock, using a well hidden scar, or can be harvested from both buttocks when providing a bilateral breast reconstruction.
The flap is elevated while the patient is sleeping face down, and then the patient is flipped to allow the flap to be attached to the chest using a surgical microscope. A marked disadvantage to this type of reconstruction would be that it is technically more difficult to perform. Additionally the tissue from the buttocks is more firm and therefore is more difficult to shape into a breast.
Other flaps used even less in the breast reconstruction include the Rubens free flap, and the lateral transverse by free flap. These techniques, and a small handful of others are rarely used because their advantages are specific and have limited application. Dr. Seify is happy to discuss the and other rarely use methods if patients have a desire to learn more about them as they make their breast reconstruction decision.