Introducing the sc-GAP Flap: A New Approach to Microsurgical Breast Reconstruction ABSTRACT Background Consistent septocutaneous perforators exist between the gluteus maximus and medius muscles. The existence of these septocutaneous perforators obviates the need for any intramuscular dissection when elevating a gluteal artery perforator flap. In this study, the authors present their experience with the septocutaneous gluteal artery perforator (sc-GAP) flap for microsurgical breast reconstruction. Methods The authors retrospectively reviewed 11 consecutive sc-GAP flaps per- formed for postmastectomy breast reconstruction in nine patients between February and July of 2008. Patient demographics, risk factors, perforator characteristics, operative technique, operative time, and outcome were analyzed. Preoperative imaging was used for all patients. Results Mean patient age was 52 years (range, 44 to 60 years). Mean body mass index was 22.2 (range, 17.2 to 29.1). Of the 11 flaps, five sc-GAP flaps were immediate (45 percent) and six were delayed reconstruction (55 percent); seven were unilateral (64 percent) and four were bilateral (36 percent). Mean operative time was 8.2 hours (range, 6.5 to 11 hours). All patients stayed in the hospital for 5 days. Mean pedicle length was 7.9 cm (range, 5 to 10 cm) and mean flap weight was 499 g (range, 360 to 640 g). Vessel size ranged from 1.8 to 3 mm. Complications included one take-back, one axillary seroma, one donor-site seroma, and one donor-site hematoma. There were no flap losses. Conclusions The sc-GAP flap is a viable technique for microsurgical breast reconstruction that may be easier to master than traditional musculocutaneous gluteal artery perforator flap procedures. The authors recommend the sc-GAP flap as a simplified approach to gluteal artery perforator flaps for microsurgical breast reconstruction. 64
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