Superior Gluteal Artery Perforator Flap for Breast Reconstruction: Retrospective Evaluation of 51 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 in which 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 study was to evaluate the overall aesthetic and functional outcome of breast reconstruction with the SGAP flap, and to compare outcome and complications with the results of breast reconstruction with the DIEP flap. Between June 1999 and November 2004, 51 SGAP flaps were used for breast reconstruction in 32 patients. Thirteen patients underwent a unilateral and 19 patients a bilateral SGAP reconstruction. Thirty-five reconstructions were immediate and 16 delayed. Functional and aesthetic outcome was assessed by means of a clinical examination by an independent panel 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 at the center. Data were gathered retrospectively. There was one total flap loss (1.9%) and one partial necrosis (1.9%). Four flaps (7.8%) needed secondary revision of the anastomosis. Six patients (11.7%) had a donor site seroma, and one patient (1.9%) a breast seroma. Fat necrosis and fibrosis were encountered in 4 flaps (7.8%), one of them after radiotherapy. Overall, 6 flaps (11.7%) required complication-related secondary surgery, and the overall complication rate was 25.5%. In the series of the first 100 DIEP flaps, the overall complication rate was 12%, and secondary surgery was performed in 5% of flaps. Seventy-four percent of patients rated the shape of the breast as excellent or good, and breast symmetry was rated excellent or good in 66%. Contour and symmetry at the donor site were rated fair and poor in 36% and in 16% of patients, respectively. There was no functional deficit at the donor site. Overall satisfaction was excellent or good in 80% of the patients. The SGAP flap is a good alternative for breast reconstruction when a DIEP flap is not available. However, the complication rate is statistically higher and donor-site contour deformity remains a major complaint. A more cranial placement of the donor site