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Like TUG flap reconstruction, the GAP flap technique is an alternative to abdominal flap procedures. In GAP flap breast reconstruction, skin and fat are harvested from one or both buttocks (for unilateral or bilateral breast reconstruction). Blood supply for this transferred tissue is provided by perforator vessels, which are teased out from the gluteal muscle through small incisions. As with DIEP and SIEA flap reconstruction, the muscle itself does not have to be harvested for transfer. Both the superior and inferior gluteal vessels can be utilized with the number of perforators required determined during surgery.

Once the flap has been elevated and the appropriate amount of skin and tissue has been harvested, incisions in the buttocks will be closed and the patient will be turned over so that the flap can be secured to the chest wall. The perforator vessels will then be attached microscopically to recipient blood vessels on the chest wall providing blood supply to the newly formed breast. In order to complete GAP flap breast reconstruction, the position of the patient must be changed during surgery and this approach tends to be technically more difficult than other procedures. However, for patients with insufficient abdominal tissue, it can still afford them natural looking results.

Risks and Benefits

The most significant disadvantage associated with GAP flap breast reconstruction is its difficulty. The procedure itself is more difficult than other natural tissue flap reconstruction techniques because of the relationship between the donor and mastectomy site. Also, the tissue from the buttocks tends to be harder to shape into a natural breast substitute as compared to tissue from the abdomen or inner thigh. Despite these disadvantages, GAP flap reconstruction can produce quality outcomes and is a good alternative when other donor sites are unavailable.


Women who are seeking natural tissue reconstruction but are not suited for abdominal flap surgery may be good candidates for GAP flap breast reconstruction. Natural tissue reconstruction is frequently preferred over implant reconstruction for patients that are at increased risk of implant-related complications. This includes patients who have a history of chest wall radiation or who have had previous problems with an implant reconstruction. Insufficient abdominal wall tissue or a history of previous abdominal surgery can potentially make a woman a poor candidate for abdominal flap reconstruction. Also, if there is limited inner thigh tissue, than GAP flap breast reconstruction may be the right approach. We can determine during your initial consultation which procedure will be most effective at meeting your needs.