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Baek et al. Plast Aesthet Res 2024;11:49 https://dx.doi.org/10.20517/2347-9264.2024.91 Page 9 of 11

Importantly, the purpose of reconstructive surgery for women who have undergone mastectomy must not
be disregarded. Opsomer et al. compared BREAST-Q scores of lumbar perforator (LAP) flaps (50 patients)
[11]
and SGAP flaps (25 patients) with DIEP flaps (153 patients) . While there were no significant differences
in satisfaction with their breast outcomes among the three flaps, patients with LAP and SGAP flap
reconstruction were found to have lower psychosocial well-being and sexual well-being scores compared to
those who underwent DIEP flap reconstruction. Patients with LAP flaps had lower physical well-being
scores associated with their donor site than DIEP and SGAP patients. An explanation of the differences in
these scores could include a variety of factors. DIEP flap scars tend to be well hidden beneath
undergarments while giving improved abdominal contour, whereas LAP flap scars will reside higher above
undergarments. While SGAP flap scars will remain hidden beneath undergarments as we have described,
there is an effect on the overall contour of the buttocks. This study takes into consideration the importance
of “holistic” care, where the quality of postsurgical survivorship is evaluated in addition to the technical
outcomes. An important limitation of this study was its retrospective nature and the lower number of SGAP
and LAP patients compared to DIEP patients, which leaves the potential for underpowering.

Overall, the final breast mound shape will tend to have greater projection compared to other autologous
reconstructions. However, the final breast mound may require revisions due to the more rigid nature of the
flap that may not drape as aesthetically. Fat grafting and revisions can be performed to tailor the breast
mound, similar to abdominal-based breast reconstruction [Figure 7]. Contour deformity, especially in
unilateral reconstruction, can be treated with fat grafting and/or liposuction to taper the interface of the flap
with the chest wall.

CURRENT AND FUTURE DIRECTIONS
The existing literature on SGAP flaps for breast reconstruction presents opportunities for advancement. The
retrospective nature of all the studies reviewed certainly introduces the potential for biases and threats to
validity. These studies also are limited by their small number of patients. Hunter et al., Werdin et al., and
Beaumeister et al. had 16, 72, and 81 flaps, respectively [12,14,18] . Guerra et al. had approximately double the
number of flaps at 142, although this was over the course of 9 years, which they averaged 15 flaps per
year . The studies involving Sc-SGAP flap had even smaller cohorts of 11-36 patients . A multi-
[13]
[8,9]
institutional review of SGAP data and outcomes for breast reconstruction is warranted.
Lastly, although the SGAP flap has been compared to the gold-standard DIEP flap and to the LAP flap ,
[11]
[14]
many other flap options exist for breast reconstruction in lean patients, including transverse upper gracilis
(TUG) flaps and profunda artery perforator (PAP) flaps. To our knowledge, no comparison studies have
been conducted on these options, but they may spark important discussions and possibly change algorithms
for reconstruction in this patient population.

SUMMARY AND KEY POINTS
Since its introduction, the SGAP flap, over the years, has proven to be a constant and reliable option for
autologous reconstruction of the breast for patients with a lack of soft tissue available at the abdominal site.
Sufficient tissue can be harvested from the buttocks to adequately reconstruct a breast. When performing
this flap, one must be prepared for position changes during harvesting and final inset. While septocutaneous
modifications have been identified that address the short pedicle length, vessel diameter discrepancy with
the relatively larger internal mammary may need to be addressed with pedicle dissection in the submuscular
plane or the use of vascular conduits. SGAP flaps have a reliable success rate of 93%-98%, with comparable
patient satisfaction compared to DIEP flaps. Common donor site morbidities include seroma and contour