GAP Flap Breast Reconstruction

This natural tissue reconstruction approach uses tissue from the buttocks to reconstruct a breast.


GAP flap breast reconstruction transplants skin, fat, and perforator vessels from the buttocks to the chest. This flap does not compromise the underlying muscle.

This flap is suitable for patients who lack sufficient abdominal or thigh tissue for breast reconstruction. It is more technically difficult than most other natural tissue flaps. Many surgeons will perform only one GAP flap in a given surgery. That means that patients who have undergone bilateral mastectomies will require a minimum of two surgical procedures to reconstruct each breast individually.

Types of GAP Flap Breast Reconstruction Procedures


In this approach, the superior gluteal artery carries the upper back and hip soft tissue blood supply.

sgap flap

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SGAP flap includes skin and fat from the upper buttock for breast reconstruction


In this approach, the inferior gluteal artery carries the blood supply for the lower buttock soft tissue. Surgeons try to avoid this flap, because it removes lower buttock tissue, which is important when bearing weight in the seated position.

Procedure Details:

  • The patient is positioned on their stomach
  • Surgeons elevate an ellipse of skin and fat from the buttock
  • Donor site incisions are closed
  • The patient is repositioned on the back and the flap is transplanted to the chest
  • Blood vessels from the flap are connected to blood vessels in the chest using an operating microscope
  • The tissue is shaped to form a breast

Risks & Benefits

The GAP flap procedure is the most difficult type of natural tissue reconstruction. The relationship between the donor site and the mastectomy site makes it difficult to transplant the tissue. Given these challenges, it is frequently recommended that both breasts are reconstructed at different times. In most cases, each breast reconstruction should be performed separately. This is a clear drawback for patients who have undergone bilateral mastectomies. Tissue from this flap is also more challenging to shape than tissue from other areas of the body, like the back or inner thigh.

All microsurgical free flaps carry a risk of flap failure. However, this risk is extremely small when the surgery is performed by an experienced microsurgeon. It is essential to find a medical team that is experienced in these types of highly specialized procedures.

While it carries more disadvantages than other natural tissue reconstruction options, the GAP flap can be a good option for patients who have no other donor tissue and wish to avoid a breast implant.