As perforator-flap breast reconstructions become more widely embraced by the American microsurgical community, the prevalence of the GAP flap will also grow. Admittedly, the GAP flap is much more difficult a dissection than the DIEP, and the contouring and insetting can often leave a comparatively suboptimal result. In the authors' practice, they try to apply proven aesthetic techniques to the reconstructive process. They have found that placement of the donor site in the superior buttock region, similar to aesthetic “butt lift” techniques, allows the flap to include not only upper buttock fat but lower lumbar fat as well. The inclusion of lower lumbar fat allows the acquisition of more than an adequate flap base width with less impact on buttock projection and a better aesthetic outcome in the reconstructed breast. Donor-site improvements are part of every GAP flap second stage. The authors reviewed some operative techniques used to optimize outcomes.
