Composite SGAP Flap Reconstruction: Volume, Balance, and Beauty Without the Abdomen
By: Dr. Frank DellaCroce, Dr. Scott Sullivan, Dr. Chris Trahan, Dr. M. Whitten Wise, and Dr. Craig Blum
Abstract
This case report details a novel use of two independent SGAP flaps for unilateral breast reconstruction in a patient with prior abdominoplasty and failed implant reconstruction. The dual-flap approach achieved symmetry, projection, and softness using tissue exclusively from the upper buttocks while maintaining minimal donor-site impact. The patient achieved excellent aesthetic and functional outcomes with short recovery and natural contour.
Overview
When abdominal tissue is unavailable, the Superior Gluteal Artery Perforator (SGAP) flap offers an alternative donor site. In this case, both buttock regions were used to harvest two separate SGAP flaps. Each flap was independently anastomosed — one supplying the superior pole and the other the inferior — creating a composite reconstruction that restored natural shape and volume.
Why It Matters
- Enables full-volume reconstruction without abdominal tissue.
- Provides a muscle-sparing, aesthetic outcome with minimal morbidity.
- Ideal for women with prior abdominal surgery or limited donor tissue.
- Offers a solution for patients with failed implants or capsular contracture.
Surgical Innovation
This technique utilized dual microvascular anastomoses: one flap connected to the antegrade internal mammary vessels, the other to the retrograde limb using interposition grafts. The arrangement provided reliable perfusion, tension-free inset, and strong tissue viability. The donor sites were placed high on the buttocks, leaving discreet scars and preserving natural contour.
Recovery & Results
The patient experienced rapid recovery, was discharged on postoperative day three, and achieved excellent symmetry and projection compared to the contralateral breast. No complications were reported, and donor-site aesthetics remained intact.
Surgeon Perspective
Dr. Sullivan and his team note that composite SGAP reconstruction represents a critical advancement for women with limited tissue resources. It combines microsurgical mastery with patient-specific artistry, expanding access to muscle-sparing, natural-feeling breast reconstruction beyond traditional abdominal approaches.
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Learn more about Composite SGAP Reconstruction
Composite Superior Gluteal Artery Perforator Flaps for Unilateral Breast Reconstruction: A Case Report
By: Dr. Frank DellaCroce, Dr. Scott Sullivan, Dr. Chris Trahan, Dr. M. Whitten Wise, and Dr. Craig Blum
Abstract
This case report details a novel use of two independent SGAP flaps for unilateral breast reconstruction in a patient with prior abdominoplasty and failed implant reconstruction. The dual-flap approach achieved symmetry, projection, and softness using tissue exclusively from the upper buttocks while maintaining minimal donor-site impact. The patient achieved excellent aesthetic and functional outcomes with short recovery and natural contour.
Overview
When abdominal tissue is unavailable, the Superior Gluteal Artery Perforator (SGAP) flap offers an alternative donor site. In this case, both buttock regions were used to harvest two separate SGAP flaps. Each flap was independently anastomosed — one supplying the superior pole and the other the inferior — creating a composite reconstruction that restored natural shape and volume.
Why It Matters
- Enables full-volume reconstruction without abdominal tissue.
- Provides a muscle-sparing, aesthetic outcome with minimal morbidity.
- Ideal for women with prior abdominal surgery or limited donor tissue.
- Offers a solution for patients with failed implants or capsular contracture.
Surgical Innovation
This technique utilized dual microvascular anastomoses: one flap connected to the antegrade internal mammary vessels, the other to the retrograde limb using interposition grafts. The arrangement provided reliable perfusion, tension-free inset, and strong tissue viability. The donor sites were placed high on the buttocks, leaving discreet scars and preserving natural contour.
Recovery & Results
The patient experienced rapid recovery, was discharged on postoperative day three, and achieved excellent symmetry and projection compared to the contralateral breast. No complications were reported, and donor-site aesthetics remained intact.
Surgeon Perspective
Dr. Sullivan and his team note that composite SGAP reconstruction represents a critical advancement for women with limited tissue resources. It combines microsurgical mastery with patient-specific artistry, expanding access to muscle-sparing, natural-feeling breast reconstruction beyond traditional abdominal approaches.
Learn more about Composite SGAP Reconstruction