The In-The-Crease IGAP (Inferior Gluteal Artery Perforator) Free Flap

Our newest development, the In-The-Crease I-GAP Flap, is an excellent option for many women. Excess skin and fat are borrowed from the inferior buttock, leaving an improvement in buttock shape, and a scar that is almost completely hidden. For women requiring bilateral reconstruction both the SGAP and the IGAP can be performed as a bilateral simultaneous operation, so that only one operation is needed to reconstruct both breasts.

Until recently, the GAP flaps have been our second choice of donor site, reserved for patients who were not candidates for the use of abdominal tissue. However, we have found that, for many women, the best of all cosmetic results comes from harvesting skin and fat from the inferior buttock. The scar ends up within the buttock crease, and is almost imperceptible, and the patient has a tighter, lifted buttock. " The scar remains in the crease and does not migrate inferiorly over time as was the case in some cosmetic buttock lift procedures of the past. This recent realization has led us to consider the In-The-Crease I-GAP a first choice in many cases. See Pictures

The In-The-Crease IGAP is harvested using the same microsurgical, muscle-sparing techniques as the DIEP, SIEA and SGAP flaps. The advantage is that there is almost always adequate volume to make an appropriate sized breast, the donor site is often improved by the operation, and the scar is completely concealed within the inferior buttock crease.

Older operations that used the lower buttock took both fat and muscle. Despite the excellent cosmetic results, this operation was abandoned because of occasional problems with the sciatic nerve in the back of the leg. By taking only the skin and fat and leaving the muscle undisturbed, injury or exposure of the nerves is not a problem. The nerves run underneath the muscle and are completely protected by it.

Excess tissue is taken from the lower buttock to create a new breast. Ample tissue is always left for comfort when sitting. Patients report no problems with sitting postoperatively. In fact many of the IGAP patient have remarkably little or no pain.

Examples of Final Results - Post Operation Pictures

An advantage of the IGAP is that the aesthetic shape of the upper buttock is preserved.

The final result of the reconstructed breast is comparable to that of the SGAP. Deciding on the SGAP vs. the IGAP depends on patient preference and anatomy, how much tissue the patient has to donate from each site, and preference for scar location by the patient.

Restoration of the nipple and areola follow. For many women the reconstructed breast may be firmer and have a more youthful appearance than their natural breasts. Women with ample buttock tissue, sagging buttock, or sparse abdominal tissue are ideal candidates.