Advertisement

Inferior Gluteal Artery Perforator Flap in Breast Reconstruction

  • Toshihiko SatakeEmail author
Chapter
  • 57 Downloads

Abstract

For reconstructing moderate-to-high projection breasts in nulliparous patients with insufficient abdominal tissue or prior abdominal surgeries, a unilateral inferior gluteal artery perforator (IGAP) flap is an alternative procedure. In patients with slim hips, however, unilateral gluteal tissue is insufficient and inferior gluteal crease displacement may develop postoperatively. Donor-site asymmetry is also a major disadvantage. Use of bilateral IGAP flaps for breast reconstruction helps to avoid asymmetry of the inferior buttock volume and shape. Bilateral flaps provide sufficient tissue volume and allow for reconstruction of a breast comparable to the unaffected side.

Keywords

Breast reconstruction Free flap Inferior gluteal artery perforator flap IGAP flap Stacked flap Gluteal deformity 

References

  1. 1.
    Allen RJ, Tucker C Jr. Superior gluteal artery perforator free flap for breast reconstruction. Plast Reconstr Surg. 1995;95:1207–12.CrossRefGoogle Scholar
  2. 2.
    Higgins JP, Orlando GS, Blondeel PN. Ischial pressure sore reconstruction using an inferior gluteal artery perforator (IGAP) flap. Br J Plast Surg. 2002;55:83–5.CrossRefGoogle Scholar
  3. 3.
    Guerra AB, Metzinger SE, Bidros RS, et al. Breast reconstruction with gluteal artery perforator (GAP) flaps: a critical analysis of 142 cases. Ann Plast Surg. 2004;52:118–25.CrossRefGoogle Scholar
  4. 4.
    Allen RJ, Levine JL, Granzow JW. The in-the-crease inferior gluteal artery perforator flap for breast reconstruction. Plast Reconstr Surg. 2006;118:333–9.CrossRefGoogle Scholar
  5. 5.
    Levine JL, Miller Q, Vasile J, et al. Simultaneous bilateral breast reconstruction with in-the-crease inferior gluteal artery perforator flaps. Ann Plast Surg. 2009;63:249–54.CrossRefGoogle Scholar
  6. 6.
    Allen RJ, Haddock NT, Ahn CY, Sadeghi A. Breast reconstruction with the profunda artery perforator flap. Plast Reconstr Surg. 2012;129:16e–23e.CrossRefGoogle Scholar
  7. 7.
    Satake T, Muto M, Ko S, et al. Breast reconstruction using the free posterior medial thigh perforator flaps: intraoperative anatomical study and clinical results. Plast Reconstr Surg. 2014;134:880–91.CrossRefGoogle Scholar
  8. 8.
    LoTempio MM, Allen RJ. Breast reconstruction with SGAP and IGAP flaps. Plast Reconstr Surg. 2010;126:393–401.CrossRefGoogle Scholar
  9. 9.
    Mirzabeigi MN, Au A, Jandali S, et al. Trials and tribulations with the inferior gluteal artery perforator flap in autologous breast reconstruction. Plast Reconstr Surg. 2011;128:614e–24e.CrossRefGoogle Scholar
  10. 10.
    Beshlian KM, Paige KT. Inferior gluteal artery perforator flap breast reconstruction. Am J Surg. 2008;195:651–3.CrossRefGoogle Scholar
  11. 11.
    Godbout E, Farmer L, Bortoluzzi P, et al. Donor-site morbidity of the inferior gluteal artery perforator flap for breast reconstruction in teenagers. Can J Plast Surg. 2013;21:19–22.CrossRefGoogle Scholar
  12. 12.
    Satake T, Muto M, Ogawa M, Shibuya M, Yasumura K, Kobayashi S, Ishikawa T, Maegawa J. Unilateral breast reconstruction using bilateral inferior gluteal artery perforator flaps. Plast Reconstr Surg Glob Open. 2015;3:e314.CrossRefGoogle Scholar
  13. 13.
    Strauch B, Yu HL. Gluteal region. Atlas of microvascular surgery: anatomy and operation approaches. New York: Thieme; 1993. p. 102–10.Google Scholar
  14. 14.
    Ahmadzadeh R, Bergeron L, Tang M, et al. The superior and inferior gluteal artery perforator flaps. Plast Reconstr Surg. 2007;120:1551–6.CrossRefGoogle Scholar
  15. 15.
    Rozen WM, Ting JW, Grinsell D, et al. Superior and inferior gluteal artery perforators: in-vivo anatomical study and planning for breast reconstruction. J Plast Reconstr Aesthet Surg. 2011;64:217–25.CrossRefGoogle Scholar
  16. 16.
    Le-Quang C. Secondary microsurgical reconstruction of the breast and free inferior gluteal flap. Ann Chir Plast Esthet. 1992;37:723–41.PubMedGoogle Scholar
  17. 17.
    Paletta CE, Bostwick J 3rd, Nahai F. The inferior gluteal free flap in breast reconstruction. Plast Reconstr Surg. 1989;84:875–83.CrossRefGoogle Scholar
  18. 18.
    Codner MA, Nahai F. The gluteal free flap breast reconstruction. Making it work. Clin Plast Surg. 1994;21:289–96.PubMedGoogle Scholar
  19. 19.
    Boyd JB, Gelfand M, Da Lio A, et al. Comparison of superior gluteal artery musculocutaneous and superior gluteal artery perforator flaps for microvascular breast reconstruction. Plast Reconstr Surg. 2009;123:1641–7.CrossRefGoogle Scholar
  20. 20.
    Kronowitz SJ. Redesigned gluteal artery perforator flap for breast reconstruction. Plast Reconstr Surg. 2008;121:728–34.CrossRefGoogle Scholar
  21. 21.
    Cuenca-Guerra R, Quezada J. What makes buttocks beautiful? A review and classification of the determinants of gluteal beauty and the surgical techniques to achieve them. Aesthetic Plast Surg. 2004;28:340–7.CrossRefGoogle Scholar
  22. 22.
    Huemer GM, Dunst KM, Schoeller T. Restoration of the gluteal fold by a deepithelialized skin flap: preliminary observations. Aesthetic Plast Surg. 2005;29:13–7.CrossRefGoogle Scholar
  23. 23.
    Chaput B, Fade G, Sinna R, et al. “Body-lift”-like pattern for the simultaneous bilateral superior gluteal artery perforator flap in breast reconstruction. Aesthetic Plast Surg. 2013;37:52–5.CrossRefGoogle Scholar
  24. 24.
    Beahm EK, Walton RL. The efficacy of bilateral lower abdominal free flaps for unilateral breast reconstruction. Plast Reconstr Surg. 2007;120:41–54.CrossRefGoogle Scholar
  25. 25.
    Guerra AB, Soueid N, Metzinger SE, et al. Simultaneous bilateral breast reconstruction with superior gluteal artery perforator (SGAP) flaps. Ann Plast Surg. 2004;53:305–10.CrossRefGoogle Scholar
  26. 26.
    Flores JI, Magarakis M, Venkat R, et al. Bilateral simultaneous breast reconstruction with SGAP flaps. Microsurgery. 2012;32:344–50.CrossRefGoogle Scholar
  27. 27.
    Seles M, Huemer GM. Utilization of bilateral infragluteal flaps for correction of overaggressive gluteal liposuction. Ann Plast Surg. 2014;72:270–3.CrossRefGoogle Scholar
  28. 28.
    Papp C, Windhofer C, Michlits W. Autologous breast augmentation with the deepithelialized fasciocutaneous infragluteal free flap: a 10-year experience. Ann Plast Surg. 2011;66:587–92.CrossRefGoogle Scholar
  29. 29.
    Papp C, Windhofer C, Gruber S. Breast reconstruction with the fasciocutaneous infragluteal free flap (FCI). Ann Plast Surg. 2007;58:131–6.CrossRefGoogle Scholar
  30. 30.
    de Pedroza LV. Fat transplantation to the buttocks and legs for aesthetic enhancement or correction of deformities: long-term results of large volumes of fat transplant. Dermatol Surg. 2000;26:1145–9.CrossRefGoogle Scholar
  31. 31.
    Lewis CM. Correction of deep gluteal depression by autologous fat grafting. Aesthetic Plast Surg. 1992;16:247–50.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Plastic and Reconstructive SurgeryYokohama City University Medical CenterYokohamaJapan

Personalised recommendations