What Is IGAP Flap Breast Reconstruction?

Inferior gluteal artery perforator (IGAP) flap surgery is a newer type of post-mastectomy breast reconstruction that involves taking tissue from the inferior part of the buttock, where there is excess skin and fat, to create a breast mound. This procedure is an option for women who don’t have enough abdominal tissue for a TRAM flap or DIEP flap procedure, and it is the preferred option for women who want to reconstruct both breasts after a bilateral mastectomy.

Like all forms of breast reconstruction, an IGAP flap is done for aesthetic purposes at a patient's request. While it creates a new breast, know that it won't have the same appearance and sensation as your natural breast, and you will need additional surgery to create a new nipple and areola.

The removal of skin and fat from the buttock is similar to procedures for buttock lifts, but an IGAP includes relocating an artery and vein that will supply blood to the transplanted tissue.

An IGAP breast reconstruction is also similar to the superior gluteal artery perforator (SGAP) procedure, which uses fat and skin from the buttock to create a new breast mound as well. An IGAP uses tissue taken from the lower buttock, whereas SGAP uses tissue from the upper buttock. Neither procedure the moving of muscle.

Risks accompany any surgery, and breast cancer reconstruction procedures are no different. These risks include:

• Reactions to anesthesia
• Incision site infections
• Scarring, although the incision to collect the donor tissue will be barely noticeable, as it may be low enough to hide in the fold of your buttock
• Fluid build-up, pain, and swelling in the breast or buttock
• Wound healing problems

Complications, although rare, may occur later on and could include:

• Necrosis: Tissue death, in part or all of the reconstructed breast, may occur, requiring removal of the dead tissue. In this case, the surgery may need to be repeated at a later date, if possible.
• Changes or problems to the arm on the same side as the reconstructed breast
• Problems with an implant (if one is used) including leakage, rupture, or scar tissue formation
• Blood clots: After surgery, you are at risk for clots in your legs or your lungs. To prevent this, nurses will get you up as soon as possible and encourage you to move around.
• Uneven breasts: There is also the possibility of the procedure resulting in an undesirable appearance, requiring additional surgery to correct it.

Contraindications

You're not a candidate for an IGAP if:

• You have previously had lower buttock skin and fat removed
• You have had liposuction on your lower buttock
• You smoke: Smoking may cause the buttock scar to take longer to heal and fat tissue to develop into scar tissue.

Once you have made the decision to have an IGAP flap procedure, you will need to decide when to have the surgery and how to manage daily responsibilities while you recover. You'll also need to arrange for someone to take you home once you are discharged from the hospital.

Your surgeon can answer questions on what to expect from IGAP surgery and how to be as prepared as possible.

You should follow all of your surgeon’s instructions, which may include:

• Quitting smoking: If you need help quitting, your surgeon’s office can help you with medication and other resources.
• Medication adjustments: You will be provided instructions on which vitamins, medicines, and dietary supplements to avoid before surgery and for how long.

Timing

Breast reconstruction can be done during a mastectomy (immediate reconstruction) or after treatment. If you need radiation therapy to the underarm area or chest, it makes sense to wait. Having the procedure done before treatment is complete severely limits a radiation therapist's ability to properly treat you.

If you are having a bilateral mastectomy and reconstruction at the same time, surgery will take nine to 12 hours. If the procedure will only be for one breast, it will take approximately half that time. In some cases, you may have the second breast reconstructed a few months later.

Expect to stay in the hospital for about four days after the operation.

Location

IGAP flap surgery is performed in the operating room of a hospital.

Food and Drink

Follow any instructions your surgeon provides on preparing for the procedure. This may include information on diet, medications, and quitting smoking. Typically, you will be asked not to eat or drink anything for eight to 12 hours before the surgery.

Cost and Health Insurance

In the past, health plans used to deny breast construction, but federal law now requires the insurance company that managed your cancer care to pay for reconstruction costs. If you are insured, make sure your provider will not deny your breast reconstruction costs before you undergo surgery.

Insurance providers each have their own unique policies and procedures regarding precertification, predetermination, and authorization for medical procedures. When a patient has been diagnosed with cancer, this process is generally completed promptly by the insurance provider.

This surgery can be expensive; some people may face high deductibles or co-payments. Some insurance companies require a second opinion before they will agree to pay for surgery.

Medicare covers breast reconstruction, but Medicaid coverage can vary from state to state.

What to Bring

To add an element of comfort to your hospital stay and make your trip home as easy as possible, considering packing:

• Comfortable pajamas (loose-fitting is best) and a robe
• An outfit to wear home that won’t rub on your incision
• A pillow and soft blanket (also useful for your ride home)

Also, don't forget:

• Your regular medications
• Insurance card
• Paperwork you were instructed to have on hand (if any)

Leave valuable personal items, such as jewelry and cash at home.

Your healthcare team will need a couple of hours ahead of your surgery to get you squared away. Arrive at the time requested. Before your procedure, a nurse or other healthcare provider will check your vital signs. You will change into a surgical gown and, most likely, a cap. You will also be given a hospital ID bracelet.

Pre-Surgery

You will not be awake during your mastectomy or reconstruction, so you will have intravenous sedation or general anesthesia. Talk to your surgeon and the anesthesiologist about which will work best for you.

Throughout the Surgery

Your plastic surgeon will use a skin marker to carefully plan for the incision that will create your skin flap. An ellipse will be drawn across your lower buttock(s). If you are having immediate reconstruction, your general surgeon will remove your breast, sparing as much skin as is safe to keep.

Using the skin markings, your surgeon will make an incision on your lower buttock and raise a layer of skin and fat. Before disconnecting this tissue flap, they will search for the inferior gluteal artery perforator and vein that will provide the blood supply to your new breast. These blood vessels will be carefully moved along with your tissue flap to your mastectomy area.

In order to ensure that the tissue will survive in its new location, your surgeon will use microsurgery to reattach the blood vessels in the tissue flap to blood vessels in your chest. Your skin and fat tissue are then reshaped into a breast mound and sutured into place.

Most women have enough tissue on their buttocks to create a new breast. When this is not the case, a small implant can be tucked behind the tissue flap to help fill out the size of the new mound.

Your buttock incision will be closed and drains may be placed to promote healing and prevent fluid buildup. Your surgeon may use some marking techniques over the blood vessels to help hospital staff monitor healing as you recover.

Post-Surgery

After your surgery, you will go to the recovery room, where you'll stay until the anesthesia has worn off and your vital signs are stable. You will then move to a regular room at the hospital to begin healing. Blood flow to the flap is critical and will be closely monitored.

If you have surgical drains, you'll be taught how to empty them and keep records of the fluid volume before you are discharged. You will also be given a prescription for painkillers.

You will have two to four incisions after an IGAP flap procedure, and you may need to rest and recover for four to six weeks. Plan on wearing loose, comfortable clothing during this time. Tight jeans over a buttock incision with drains will be uncomfortable. You may be required to wear a compression bra while your breast scars heal.

Your doctor will give you instructions on how to keep the incision sites clean to reduce the risk of infection, and when you can resume bathing, exercise, and sexual activity.

About a week after surgery, if your fluid buildup has significantly decreased, you may be able to have the drains removed. It may take as long as a year for your scars to fade.

IGAP flap involves microsurgery, which requires extensive training, skill and experience, in addition to special facilities at your hospital. The sutures used to reconnect the blood vessels are about the same diameter as a strand of hair.

Your surgical team will be using special tools and a high-power microscope to perform the most critical part of this procedure. Choose a surgeon for this reconstruction carefully and ask plenty of questions until you feel good about your decision.

A Word From Verywell

Deciding whether or not to have breast reconstruction after a mastectomy is a personal choice. Breast reconstruction is not medically necessary, but having a reconstruction may help you to manage your emotional and physiological well-being, life quality, and overall outlook.

Research has shown that women are happier with how their reconstructed breasts look after microscopic flap procedures, such as the IGAP, than when they opt for prosthetic breast implants.

Make sure you discuss all the pros and cons of the various options with your surgeon before you decide to have the IGAP flap procedure.