A GAP Flap – or Gluteal Artery Perforator Flap – is an autologous breast reconstruction technique that uses excess skin and fat from the gluteal region (buttocks) to form the breasts. This procedure choice is popular with women who do not have enough tissue for a DIEP Flap or women who had previous abdominal surgery. GAP flap surgery is a muscle sparing procedure, which means it leads to relatively faster recovery time while preserving muscle function in the donor area. However, the procedure is very difficult to perform and requires the hands of an experienced breast reconstruction microsurgeon.
Phoenix plastic surgeon Dr. Tessler and Dr. Turin use microsurgical techniques to remove tissue and blood vessels from the buttocks and then use them to recreate the renewed, live tissue in the breast. The surgeon takes great care to preserve the gluteus maximus muscle and nerves in order to ensure an optimal outcome with proper healing. Dr. Tessler and Dr. Turin take each patient as unique and develops a customized GAP reconstruction to suit their goals. He has helped many mastectomy patients from Phoenix, Scottsdale, Glendale, Mesa, Gilbert, and surrounding AZ cities feel whole again after battling breast cancer.
Am I a Candidate for GAP Reconstruction?
This is a natural breast reconstruction technique using flaps of skin and fat from the buttocks and then stacking them in order to recreate a new breast. Because excess skin and fat are removed from the buttocks, having the GAP flap can mean that your buttocks will be tighter – as if you had a buttock lift. You may be an ideal candidate for this type of breast reconstruction if:
- Desire a breast reconstruction using your own natural tissue
- Have a slender body shape
- Lack sufficient tissue in the abdominal region to form a breast mound of the desired size
- Have experienced failure of a previous abdominal flap
- Have experienced failure of a previous breast implant
- Have had prior abdominal surgery
During your breast reconstruction consultation with Dr. Tessler and Dr. Turin, the surgeon will listen to your concerns, examine your body, and study your medical history before letting you know whether GAP reconstruction is for you. If your body type or medical history does not permit this procedure, Dr. Tessler and Dr. Turin have many other autologous techniques that can still be used.
Types of GAP Flaps
There are two main types of GAP flap reconstruction procedures, depending on the section of the gluteal artery that is used:
- SGAP (Superior Gluteal Artery Perforator) – in this type of GAP reconstruction, the gluteal artery section that is used is located towards the upper part of the butt and the cut will be placed near the ‘love handle’ or upper hip area.
- IGAP (Inferior Gluteal Artery Perforator) – in IGAP technique, the gluteal artery section that is used for donor tissue is located towards the lower part of the butt and the cut is placed within the buttock crease.
Dr. Tessler and Dr. Turin are uniquely positioned to recommend the best-suited type of GAP procedure to suit your body type and specific procedure goals.
GAP Flap Surgery Benefits
The GAP breast reconstruction approach offers several unique benefits.
- Buttock reshaping – since excess skin and fat is removed from the buttocks area, this breast reconstruction approach naturally results in a bonus ‘buttock lift’. In the case of the SGAP, where excess tissue is removed near the ‘love handles’, the technique results in bonus contouring within this area.
- No implant complications – this is an autologous procedure where tissue from the patient’s own body is used to form the new breast shape. This means patients do not have to deal with implant-related complications such as rippling, rupture, capsular contracture, or the need for multiple revision procedures to exchange the implants.
- Muscle sparing technique – unlike some other autologous techniques, GAP Flap does not use muscle tissue to form the new breast. This results in a faster recovery with reduced morbidity in the donor site.
- Natural look and feel – since natural tissue from the patient’s own body is used – as opposed to artificial implants – GAP reconstruction results in a natural feeling and natural-looking outcome.
Drawbacks of GAP Surgery
GAP flap reconstruction has a few drawbacks:
- Complex procedure – this is a highly complex procedure that needs immense surgical expertise. The key for patients is to find the right plastic surgeon in order to ensure the best possible outcome.
- Longer surgery time – this surgery takes a long time to complete because tissue has to be harvested from another area of the body and then used to form the new breast mound. This means patients will have multiple incision points and scarring.
Dr. Tessler and Dr. Turin utilize advanced surgical techniques to deliver the best possible outcome while minimizing the risk of scarring, infections, and other complications associated with autologous breast reconstruction surgery.
GAP flap plastic surgery is performed at an accredited medical facility under general anesthesia or IV sedation. The surgeon will create an incision of the right size and pattern based on the particular donor site (SGAP or IGAP) and then remove a portion of skin and fat along with the attached blood supply. This tissue will then be transplanted to the chest and reconnected to the blood supply there in order to form a living, natural breast. This procedure takes between 5 and 7 hours to complete. Once the surgery is done, the patient is moved to the surgeon’s recovery room where their heart rate, blood pressure, and body temperature are monitored. If the patient’s vitals are doing well, they will be moved to a hospital room where they can expect to stay for about 3-5 days as they recover and regain their strength.
Recovery after GAP Surgery
Before you are discharged from the hospital, you will be told how to care for your dressings, staples, stitches, and surgical drains. The surgeon may also require you to wear a compression garment for up to 8 weeks to help with healing. Since you have just had simultaneous surgery at two sites (the buttocks and the breast(s)), you may feel worse than someone who just had mastectomy alone. Soreness and swelling usually subsides within a few weeks. Dr. Tessler and Dr. Turin will provide pain medication to increase your comfort level, as well as antibiotics to prevent infections. You will be required to commit as much time as possible to resting and recovery. Many patients are able to resume light daily activities within 6 weeks. However, intense activities such as strenuous sports, heavy lifting, and sexual activity should be avoided for 8-12 weeks after GAP flap surgery. How long it takes each patient to heal will depend on the extensiveness of the procedure as well as their body’s unique healing ability.
After your GAP surgery in Scottsdale, Phoenix, Gilbert, Mesa, or surrounding Arizona cities, Dr. Tessler and Dr. Turin will ask that you attend a number of post-operative visits that are important to monitor your recovery progress. The surgeon will use these visits to check your incision points, check for abnormalities, and generally assess your recovery progress. It is paramount that you attend all post-operative appointments and firmly adhere to your surgeon’s recovery instructions in order to ensure speedy and optimal healing.
Financing your Procedure
Cancer diagnosis is often an overwhelming, life-changing occurrence. In addition to the physical and emotional turmoil, many women have to battle with the financial implications that this diagnosis brings. While not everyone will choose to have reconstruction after the mastectomy, it is important to know what your options are. The Women’s Health and Cancer Rights Act (WHCRA) of 1998 requires all group health insurance plans that pay for mastectomy to also cover all stages of breast reconstruction, including corrective procedures, insertion of prosthesis, as well as post-mastectomy lymphedema. Your health insurer should pay for breast reconstruction, whether it is done at the same time as the mastectomy/lumpectomy, or years later. This includes reconstruction procedures that may be needed over time to improve the reconstructed breast or create a balance between the two breasts. Keep in mind though that government and church-sponsored plans are not always required to cover reconstruction, so you may need to check with your insurance provider.
Schedule your GAP Breast Reconstruction in AZ
Working with a highly experienced, board-certified plastic surgeon is the first step towards ensuring a successful breast reconstruction procedure. Dr. Tessler was appointed assistant and associate professor of Plastic Surgery at Louisiana State University and Tulane University. He has also served as Director of Plastic Surgery at University Medical Center, as well as contributed important research in the field and trained dozens of the upcoming plastic surgeons. Dr. Tessler’s passion lies in restoring form and function while improving the quality of life of his patients. He brings a friendly and personalized approach to reconstruction surgery while working with highly qualified anesthesiologists and other support staff who strive to deliver the best GAP Flap surgery Phoenix, AZ has to offer. Get in touch with Tessler Plastic Surgery to schedule your first appointment today.