Secondary Flaps: PAP and SGAP
Some patients may not be a candidate for the DIEP flap reconstruction. These patients may have a history of previous abdominal surgery that may have affected the DIEP vasculature. Examples of such procedures could be a prior abdominoplasty (aka tummy tuck) or liposuction. Other patients may have more volume at the other donor sites of the buttocks or thighs when compared to the abdomen.
In these instances, patients may be candidates for autologous reconstruction from a secondary site. Our commonly preferred secondary sites include the PAP (inner thigh) and SGAP (upper gluteal region) flaps. Just as is performed with the DIEP procedure, both the PAP and SGAP flaps involve harvesting the skin and fat from these various regions along with their respective blood supply to reconstruct a more natural-appearing breast.
Various factors can influence a patient’s candidacy for these secondary flaps, which include having an adequate volume from the donor site. In some instances, you may benefit from a combination implant and autologous reconstruction with a secondary flap. While the incisions can be hidden in clothing, patient acceptance of scar patterns is important for all autologous reconstructive cases.
At Breast Reconstruction Associates, we would be happy to discuss your reconstructive needs and design the best plan using a secondary flap if the DIEP flap is not an option for you. Please call your local Forth Worth, Austin, or Oklahoma City office to schedule a consultation today.
FAQs
Patients who have undergone prior abdominal procedures such as a tummy tuck or liposuction may have compromised blood vessels in the abdomen, making DIEP flap reconstruction unsuitable. A thorough surgical history review helps determine eligibility.
The PAP flap uses tissue harvested from the inner thigh, while the SGAP flap draws from the upper buttock region. The choice between them depends on where the patient has the most available tissue volume and their personal comfort with scarring in each area.
Because both procedures use the patient’s own living tissue including skin, fat, and blood vessels the results tend to feel more natural compared to implant-only reconstruction, and the breast can change naturally with the body over time.
Yes. In cases where the donor site doesn’t provide enough tissue volume on its own, surgeons may recommend a hybrid approach that pairs a secondary flap with an implant to achieve the desired breast shape and size.
Scars are typically placed in areas that can be concealed by standard underwear or swimwear. However, scar placement and appearance vary by individual, so discussing expectations with your surgeon beforehand is an important part of the planning process.
Recovery timelines are broadly similar to DIEP flap surgery since all three are microsurgical procedures. Full recovery generally takes several weeks, with activity restrictions in the early stages. Your surgical team will provide a personalized recovery plan.
A consultation with a reconstructive specialist is the best way to evaluate your donor site volume, medical history, body type, and aesthetic goals. Surgeons at Breast Reconstruction Associates assess each patient individually to recommend the most appropriate reconstructive plan.