IGAP Flap Breast Reconstruction

Plastic Surgery to Restore Breast Symmetry

Inferior gluteal artery perforator (IGAP) flap breast reconstruction is a newer type of breast reconstruction that involves taking a flap from the inferior part of the buttock, where there is excess skin and fat. This procedure is an option for women who don’t have enough abdominal tissue. The reconstructed breast 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.

An IGAP breast reconstruction is similar to the SGAP procedure, which also uses fat and skin from the buttock to create a new breast mound after a mastectomy. It differs in only one way-in that an IGAP uses tissue taken from the lower buttock, SGAP uses tissue from the upper buttock. Both are free flap reconstructions that use microsurgery to reconnect an artery from tissue flap to your chest area to create a breast mound.

Are You a Candidate?

Most women have enough tissue on their buttocks to create a new breast, but if there is not enough tissue, a small implant can be tucked behind the tissue flap to help fill out the size of the new breast. The removal of skin and fat from the buttock is similar to procedures for buttock lifts but a IGAP includes an artery and vein that will supply blood to the transplanted tissue.

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

Positive aspects to an IGAP surgery include:

  • Being a good option if you don't have ample tummy fat
  • Being a good option for anyone who has enough skin and fat on the lower buttock
  • No cutting or moving of muscle, speeding recovery time
  • A buttock lift from gluteal skin and fat removal
  • A high rate of success

Negative aspects of an IGAP may include:

  • Two scars from two surgery sites
  • If the IGAP fails, the tissue flap may die and will have to be completely removed
  • If reconstruction fails, you must wait 6 to 12 months to try again

Before Surgery

Deciding on whether to have breast reconstruction-regardless of the nature of the procedure-is a very personal choice. Many women mourn the loss of their breast(s) from cancer. As a result, many will choice breast reconstruction surgery.   

Once you have made a decision to have a IGAP flap procedure, you will need to make additional decisions about when to have surgery, managing life and caring for loved ones while you recover, and whether you will have surgery on both breasts so that both breasts match. 

Before surgery, make sure your insurance company will not deny your breast reconstruction costs. Your surgeon’s office can help if the insurance company denies your procedure.  In the past, health plans used to deny breast construction, but federal law requires the insurance company that managed cancer care to pay for reconstruction costs. Insurance companies often approve initial denials on appeal.

Your surgeon can answer questions on what to expect from IGAP surgery and how to be as prepared as possible. You should ask questions about the procedure, pain management, surgical risks, and recovery. 

You should follow all of your surgeon’s instructions. Instructions may include:

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

Have a plan for who will take you home after surgery and who stay in the hospital with you. You may also need help at home for a few days or longer after surgery.  

Planning ahead of time for your surgery will help you to feel anxious about the procedure and will also stress that would otherwise hinder your recovery. 

During Surgery

You will have intravenous sedation or general anesthesia during your mastectomy and reconstruction. 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. If you are having a mastectomy and reconstruction at the same time (immediate reconstruction), your general surgeon will remove your breast, sparing as much skin as will be safe to keep.

Moving Fat, Skin, and Blood Supply

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, he will search for the inferior gluteal artery perforator and vein that will give a dependable blood supply to your new breast. These blood vessels will be carefully moved along with your tissue flap.

Closing the IGAP Flap Incision

Your buttock incision will be closed and drains may be placed to promote healing and prevent fluid buildup. This incision will be barely noticeable, since it may be low enough to hide in the fold of your buttock. You will have a butt lift as a result of this part of the procedure.

Creating Your New Breast

Your tissue flap, complete with blood vessels, will be moved up 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.

The natural contour of the lower buttock makes a good continuation of the curve of your remaining breast skin. Your surgeon may use some marking techniques over the blood vessels, to help hospital staff monitor their healing as you recover. You should expect to have surgical drains in this incision to help with healing.

After Surgery

Plan on wearing loose, comfortable clothing for the next few weeks after surgery. Tight jeans over a buttock incision with drains will be uncomfortable. You should plan on staying in the hospital for three or four days after this surgery, and expect to have nurses keeping an eye on your healing.

About a week after surgery, if your fluid buildup has significantly decreased, you may be able to have the drains removed. You'll have to rest four to six weeks after an IGAP, so make sure someone will be around to do driving and lifting for you.

Double Mastectomy

If you have enough skin and fat on both buttocks to create two new breasts, you can have a bilateral simultaneous IGAP flap reconstruction after a double mastectomy. If you've already had buttock tissue used for breast reconstruction (SGAP flap) then you must choose a different method (DIEP, lat flap, or implant).

Special Considerations

The IGAP uses buttock tissue that has a contour similar to the contour of your natural breast, so many plastic surgeons think it results in a better breast reconstruction than an SGAP procedure. IGAP flap is 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.

Risks

Risks go along with any surgery and breast cancer reconstruction procedures are no different. Your surgeon will explain all the risks of reconstruction surgery with you, but be sure to ask questions if there is anyone you are not sure about or concerns you. 

It is a also a good idea to ask about the risks associated with:

  • Anesthesia use
  • Blood clots
  • Incision site infections
  • Scarring
  • Fluid build-up, pain and swelling, in the breast or the donor site
  • Wound healing problems

Major issues are usually addressed with careful planning (i.e. the use of antibiotics before, after, and during surgery) and follow-up instructions, or only have a small likelihood of occurring.  But it is still important to educate yourself about the risks, so you can get in touch with your doctor if symptoms or pain concern you.

A Word From Verywell

While you will experience some pain and discomfort during recovery after your breast reconstruction surgery, your surgeon will provide you with instructions for reducing the potential complications. This may include instructions for keeping the incision sites clean and taking medications prescribed for pain and to reduce the risk for infection. Both go a long way in ensuring a positive outcome from your breast reconstruction. Moreover, working with right plastic surgeon also helps to ensure you are happy with the results. 

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