What is SGAP Breast Reconstruction?
Our Center pioneered bilateral Superior Gluteal Artery Perforator (SGAP) breast reconstruction in 2005. The SGAP procedure is an advanced microsurgical technique that is used to rebuild the breast lost to mastectomy. Living fat is transplanted to the chest from unwanted excess from the upper hip region to give back volume and shape in the newly reconstructed breast while imparting a “butt lift” in the donor site. The Center for Restorative Breast Surgery is more experienced than any other facility in the world for this technique and the Center’s surgeons have lectured extensively around the world on its application.
When is the SGAP Breast Reconstruction Technique Used?
The SGAP technique is used to recreate a soft, natural breast composed entirely of living fat. It is used when the tummy tissue is too thin or when a previous abdominoplasty prevents DIEP breast reconstruction. This “second” donor site typically provides adequate tissue even in the most athletic body types.
In almost every case, the SGAP procedure can be done on the same day as mastectomy; this is known as “immediate reconstruction.” It may also be performed as its own procedure post-mastectomy, which is known as “delayed reconstruction.” Almost ALL women are candidates for immediate reconstruction, so speaking with your team prior to mastectomy about reconstruction is important.
The SGAP technique is suitable for both unilateral and bilateral mastectomy reconstruction and one or both breasts may be reconstructed on the same day. Older protocols required performing one breast at a time over several months, but our work at the Center for Restorative Breast Surgery established advances that eliminate this barrier and, 10 years later, our team remains a global leader in SGAP breast reconstruction.
What are the Benefits of SGAP Breast Reconstruction?
There are several benefits of the SGAP breast reconstructive technique. The recreation of the breast with soft, warm, living fat is permanent and doesn’t require maintenance imaging or repeat surgeries. For women who have undergone a mastectomy in the past, the SGAP procedure allows for the avoidance of tissue expanders.
An important benefit of the SGAP breast reconstruction over the TRAM and TUG flap is that the muscle of the donor site is protected and full strength is preserved. Avoidance of injury to the gluteal muscles protects full function and return to normal activities.
Making the incision high on the hip preserves feminine form and provides a buttocks lift as a compliment to the collection of fat to recreate the new breasts. In contrast to the PAP and IGAP procedures, which cut through important sensory nerves (posterior femoral cutaneous nerve), the SGAP procedure is purposely designed to protect from any risk of sciatic or other nerve injuries.
More importantly, the SGAP breast reconstruction procedure doesn’t take fat away from the padded areas in the lower buttock and upper thigh, as occurs in the IGAP and PAP procedures respectively. This prevents long-term discomfort while sitting and eliminates the risk of tissue breakdown over the bony structures in the weight-bearing pelvis as tissues age.
We place the incision so that it is hidden by small undergarments and bikini swimwear to ensure that once healed, women feel confident and unrestricted in their activities as the scar is not visible.
What are the Risks Associated with the SGAP Breast Reconstruction Procedure?
As with any surgery, the risks of surgery can be minimized by carefully following your pre-surgical instructions. If you have other medical problems or factors that increase your risk, we will work with you to educate you on proper preparation and arrange your clinical care regimen to maximize your safety and ensure a successful recovery.
What to Expect Throughout the SGAP Breast Reconstruction Procedure
PRE-SURGERY OFFICE VISIT
In most cases, you will be seen in our office 1-2 days prior to your surgery. At that time, we will go over the planned procedure, review consents, answer any questions you may have, and apply any surgical planning markings as may be required.
The SGAP Breast Reconstruction Operation
When you arrive at the hospital, you will be escorted to the preoperative holding area where you will change into a gown and be given foot coverings. The nurse or anesthesiologist will start an IV so that fluids and necessary medications may be given to you. Family members will be allowed to visit with you in the preoperative area once you are prepared for surgery.
After your surgery is complete, you will awaken in the recovery room under warm blankets with a dedicated nursing attendant at your side. You will be carefully monitored and kept comfortable. You will then be transferred to a private inpatient room that is prepared to allow you to rest and recover under the supervision of your attending physician and nurses. One adult caregiver may stay with you overnight during your hospitalization. A fold-out Murphy bed has been integrated into your room for their individualized comfort.
Your procedure will be performed in a state-of-the-art operating suite that is part of a fully accredited hospital that has been recognized by the American College of Surgeons for Excellence in care quality. Highly trained professionals using the most modern equipment and techniques will attend to you. In addition to your surgeons, the surgical team includes anesthesiologists, operating room technicians, nurses, and physician assistants.
You will experience some changes that are quite common after surgery and may include:
Some mild swelling and bruising is to be expected after surgery and will gradually subside in a few weeks.
Some soreness is normal after surgery but we will provide medications to maximize your comfort and help speed your recovery. Intermittent muscle spasms and feelings of tightness are normal and will subside as your swelling resolves.
Scar lines tend to improve in appearance for up to a year and are usually faded by 12-18 months.
Some numbness in the skin is normal after surgery. Occasionally the recovery of sensory nerves can result in tingling, itching, or mild electrical sensations that come and go. These sensations will resolve over time and are usually accompanied by some return of feeling in the skin.
You may resume your normal activities as recommended by your surgeon. In most cases, avoidance of strenuous activity is recommended for 4-6 weeks. As a general rule, most patients can drive between 2-3 weeks after surgery if you are no longer using pain medication and your doctor has cleared you. It is recommended to perform gentle stretches for the shoulders beginning in the early weeks after your procedure. Your clinic team can provide specific instruction for a post-mastectomy range of motion exercises as applicable. You should maintain the full range of motion within the early weeks post-operation. Patients are generally released to return to full activities and work schedule between 4-6 weeks after surgery. Your clinic team will provide any necessary documentation for your employer.
Returning Home Post Operation
If you are traveling from out of state or internationally for care with us, your caregiver will need to be with you throughout your stay post-discharge and on the same flight home to assist you in the airport. Your caregiver’s education will be provided by our nursing staff during your time with us and our team is available to you and your assistant 24 hours/day should any questions arise after you are released from the hospital. Your arrangements for assistance after surgery should include an estimated week to ten days of availability from your caregiver.
The Team at Center for Restorative Breast Surgery is Here for You
Be reassured that you are being attended to by some of the most highly skilled and dedicated healthcare providers in the world. Do your best to relax knowing that we are going to take excellent care of you from the moment you enter our facility. Do not hesitate to ask for any special needs you may have.