Superior Gluteal Artery Perforator Flap for Breast Reconstruction: Retrospective Evaluation of 39 Flaps

Breast reconstruction with the deep inferior epigastric artery perforator flap (DIEP) is generally accepted as the standard treatment for breast reconstruction after mastectomy. In cases where the use of the DIEP flap is impossible, the superior gluteal artery perforator flap (SGAP) has been described as a valuable alternative for autologous reconstruction. It is used in approximately 8.6% of autologous reconstructions at the authors' center. The purpose of this reported study was to evaluate the overall aesthetic and functional outcome of breast reconstruction with the SGAP flap and to compare outcomes and complications with the results of breast reconstruction with the DIEP flap.

Between June, 1999 and April, 2004, 39 SGAP flaps were used for breast reconstruction in 24 patients. Nine patients underwent a unilateral and 15 patients a bilateral SGAP reconstruction. Twenty-seven reconstructions were immediate and 12 delayed. Functional and aesthetic outcome was assessed by means of a clinical examination by an independent panel of students and a questionnaire evaluating aesthetic outcome, donor-site morbidity, and overall satisfaction. Complications of SGAP reconstruction were compared with complications in the first 100 DIEP flap breast reconstructions. Data were gathered retrospectively.

There was one total flap loss (2.6%) and one partial necrosis (2.6%). Three flaps (7.7%) needed secondary revision of the anastomosis. Six patients (15.4%) had a donor-site seroma and one patient (2.6%) a breast seroma. Fat necrosis and fibrosis were encountered in three flaps (7.7%). Overall, five flaps (12.8%) required secondary surgery, and the overall complication rate was 30.8%. In the authors' series of the first 100 DIEP flaps, the overall complication rate was 12% and secondary surgery was performed in 5% of flaps. Postoperative fat necrosis and fibrosis occurred in eight flaps (8%). The shape of the breast was rated excellent or good by 70.8% of patients, and breast symmetry was rated excellent or good by 62.5%. Contour and symmetry at the donor site were rated fair or poor by 36.3% and 13.6% of patients, respectively. There was no functional deficit at the donor site. Overall satisfaction was excellent or good in 78% of patients. The SGAP flap is a good alternative for breast reconstruction when a DIEP flap is not available. However, the complication rate was statistically higher and donor-site contour deformity remained a major complaint.