SGAP Breast Reconstruction

SGAP Breast Reconstruction Surgery


Our Center pioneered bilateral Superior Gluteal Artery Perforator (SGAP) Flap breast reconstruction in 2005.

The SGAP Flap breast reconstruction procedure is an advanced microsurgical technique that is used to rebuild the breast tissue lost to mastectomy after breast cancer. 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 “buttock lift” in the donor site.
The Center for Restorative Breast Surgery is more experienced in this perforator flap technique than any other facility in the world. Pioneering its advancement, our Center’s surgeons have lectured extensively around the world on its application.


An autologous breast reconstruction procedure, the SGAP technique is used to recreate a soft, natural breast composed entirely of living fat. It is used when the abdominal tissue is too thin or when a previous abdominoplasty prevents DIEP breast reconstruction. This “second” donor site, the upper buttock area over the gluteus maximus muscle, typically provides adequate skin tissue even in the most athletic body types.

In almost every case, this tissue flap procedure can be done on the same day as the 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.

10 years later, our team remains a global leader in SGAP Flap breast reconstruction.


There are several benefits of the SGAP breast reconstructive technique. The recreation of the breast with soft, warm, living fat with buttock tissue is permanent and doesn’t require maintenance imaging or repeat surgeries. For women who have undergone a mastectomy in the past, the SGAP Flap reconstructive surgery 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 area is protected, and full strength is preserved. The 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 Flap 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 work to 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 with any surgery, the risks of SGAP Flap reconstruction 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.



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.


When you arrive at St. Charles Surgical 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.

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.


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 will be integrated into your room for individualized comfort.


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 at 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 seven to ten days of availability from your caregiver.


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.

Our team is here to listen, guide, and support in whichever way we can. Whether you’re interested in the SGAP procedure or our other advanced breast reconstruction services, we invite you to learn about your options directly from us.

Schedule a call with our care navigators and let us take the next step with you.


The following contains images of advanced surgical breast reconstruction results and includes nudity.

Previous Mastectomies and Attempted Implant Reconstruction at Another Center

Before & After Remaining Implant Removal and Corrective Breast Reconstruction with SGAP Flaps

Right Breast Cancer

Before & After Bilateral Nipple Sparing Mastectomy and SGAP Flap Breast Reconstruction

Right Breast Cancer

Before & After Bilateral Nipple Sparing Mastectomy and SGAP Flap Breast Reconstruction


Before & After Bilateral Nipple Sparing Mastectomy and SGAP Flap Breast Reconstruction

Left Breast Cancer

Before & After Bilateral Nipple Sparing Mastectomy and SGAP Flap Breast Reconstruction

Hear From Our Patients

  • “Recovery is going very well only two and a half weeks after surgery. Looking back over the past two months I cannot believe the whole process has moved along so quickly and so well”