What is an SGAP Flap?
Even if you do not have an ideal amount of tissue on your abdomen for autologous flap breast reconstruction, you may qualify for the superior gluteal artery perforator (SGAP) flap. Houston, TX board-certified plastic and reconstructive breast surgeon Dr. Aldona J. Spiegel can find ways around the lack of tissue with the SGAP and rebuild your breasts with the skin, fat, and the tiny blood vessels taken from the buttocks area to achieve a B or C cup breast size. Using the top section of the buttocks, the tissue removed will look like you have had a cosmetic butt lift. This is a muscle-sparing surgery, which means you do not have to sacrifice your gluteal muscles. Transferred to the chest, the blood vessels are reconnected using microsurgery and the tissues are reshaped to create a new breast mound.
At Aldona J. Spiegel, M.D., we will educate you about this type of breast reconstruction along with other options you may be interested in. This is an intricate procedure that requires more time in surgery and several surgical sites on your front and backside of your body. Many breast cancer survivors and patients of Dr. Spiegel who have had this type of breast reconstruction report that their SGAP reconstruction was well worth it. Dr. Spiegel and her team will take you through the process step-by-step in a private consultation once you are found to be eligible for this surgery. Set up a one-on-one meeting with Dr. Spiegel at her office on the campus of Houston Methodist Hospital to get started.
"I cannot recommend Dr Spiegel and her team more highly. I attended her clinic when having trouble with uncomfortable implants after a previous mastectomy. Dr Spiegel suggested DIEP procedure and I was really not sure. Over the coming months both she and her team explained the procedure, the benefits and results and implications. I decided to go ahead and I could not be more happy with the results. I look like I would have done pre mastectomy. I have been amazed by the continued care and concern of the whole team from the finance folk to the clinic nurses and doctors and their absolute pleasure in seeing my delight. A fantastic experience and I can't thank them enough."- C.A. / Google / Aug 01, 2019
"Dr. Spiegel and her wonderful staff got me through the most difficult experience of my life. Going through mastectomy and DIEP flap reconstruction is traumatic. I chose her over other Houston area surgeons and felt that I could trust her. Everyone in her office supported me each step of the way. First, and foremost, this is a major surgery and you rely on medical excellence to avoid important risks. She is a perfectionist regarding medical safety. Next, her artistry is outstanding. She got the best result that could be possible. Finally, if you have radiation, it is a long journey of several years to get from the beginning to end of the process, involving a year of a temporary expander before the final reconstruction. It is important to have a team that you can have that trusting supportive relationship over time. I feel very lucky and grateful that I was in the hands of this wonderful group of highly skilled women."- L.S. / Google / Jul 08, 2019
"Dr. Spiegel was highly recommended by my oncologist. It had become necessary that I look into reconstruction and a lymph node transplant. Dr. Spiegel does amazing work. She loves what she does and it shows in the results that she achieves. I am very happy that I chose her for this journey! Her support staff are wonderful to work with as well!"- D.M. / Google / Jul 08, 2019
"Dr. Spiegel is my guardian angel and I owe her and her entire team and staff a debt of gratitude that I will ever be able to repay! I am one year out from my original Diep flap surgery with her and I feel great- like myself again! After undergoing a prophylactic mastectomy ( due to testing positive for the BRCA 2 gene and strong family cancer) and getting breast implants with another doctor, Dr. Spiegel saved my life by removing the implants and performing Deip surgery. The implants cased me so much pain and diminished my quality of life but now I have it back. I have no more pain and my breasts are soft again and created from my very own tissue. Thank you Dr. Spiegel!"- J.A. / Google / Jul 08, 2019
"Dr. Spiegel is simply fantastic. I am so grateful to her and her whole staff (Alexis/Nicole/Lisa/Aidee/Angie) for the wonderful care and support given to me from my very first visit to their office. Dr. Spiegel is so thorough that during the course of my visits, she insisted that I consult a GI doctor for my distended stomach. Turns out that I had an H Pylori infection for which I had to be treated. No other doctors had ever looked past their specialties to treat the whole individual, and I am 59 years old. Subsequently, Dr. Spiegel pushed for an endoscopy, and it was discovered that I had an ulcer for which I was treated. From cardio work up, lab tests to chest xrays, Dr. Spiegel ensured that I was in top shape for surgery and made sure that I understood all aspects of the procedure and treatment.During my stay at the hospital, Dr. Spiegel, Alexis, Nicole, Dr. Arroyo, and Dr. Vo infused me with so much strength, support and kindness that I have no words to express my gratitude and appreciation. It's been one month since my surgery and I'm feeling good, healing very well and going back to work next week. Awesome doctor and wonderful staff."- R.L. / Google / Jun 08, 2019
SGAP Flap Qualifications
Dr. Spiegel provides consultations with compassion and respect. If you would like to explore your options in using your own body tissue for reconstruction, then she will discuss every type of reconstruction you qualify for, even if the abdomen is not an ideal donor site for you. To qualify for the SGAP flap breast reconstruction, you may be:
- A breast cancer survivor who has had a mastectomy or lumpectomy without reconstruction
- A former breast reconstruction patient who would like to have breast implants removed and exchanged with your own tissues
- Recently diagnosed with breast cancer and would like to combine a mastectomy with breast reconstruction on one or both breasts
We would be happy to work in tandem with your oncology team, general surgeon, and any other doctor in charge of your care. Your health is what matters most to our team, and Dr. Spiegel wants you to feel empowered and have the resources you need in every part of this process.
How Is the SGAP Performed?
The SGAP flap reconstruction is performed by Dr. Spiegel in a hospital with general anesthesia. This is known to be a very long and intensive surgery since it involves both sides of your body. Dr. Spiegel will start with the collection of tissue at your donor site, which means she will take the needed amount of tissue, blood vessels, and skin from the top section of the buttocks to transfer to your chest. The blood vessels will be reconnected with microsurgery, and neurotization can also be performed on the nerve endings. No muscle will be taken from your gluteus. She will close all of your incisions using sutures with great precision and will keep the aesthetics in mind for your post-op scars. Symmetry and nipple reconstruction surgeries will occur at a later date as this surgery can take more than eight hours to perform.
SGAP Flap Monitoring
We will provide you with the right information on how to care for and assess the health of your breast flaps once you are out of our care at the hospital.
The flap skin should have the same natural coloring as your buttocks skin (where it was taken from). If it is not the appropriate flesh tone (with or without fever), Dr. Spiegel will want to see you immediately. This can signal improper blood flow.
You will also have an implanted Doppler wire in each flap that will also be tracking the blood flow in your SGAP flaps. At one of the first few visits, the Doppler will be removed during your follow-up in our office. This is at Dr. Spiegel's discretion. You will still be able to shower with the Doppler as long as you have the waterproof bandaging on correctly.
You will take notes on your drainage output for Dr. Spiegel for each surgical site in your buttocks and breasts. We track this information to know when it is appropriate to withdraw the drains from each area. Dr. Spiegel will decide when the drains will be taken out.
Other evident changes
Swelling is part of the recovery process, and you can still see/feel swelling for up to four weeks post-procedure. It is also possible to feel tiny knots in your incision site. We can address that in a post-op visit as well. Proper incision care is very important, and if you have questions at any time, we would be happy to help.
Please contact our team at Aldona J. Spiegel, M.D. for assistance with a concern, a question, or just want to talk through a concern not listed here.
In Your SGAP Flap Recovery
Dr. Spiegel may ask you to take specific medications after your surgery to help you recover more comfortably. Please continue to take your medications as directed to avoid infection and other complications. She may prescribe an antibiotic, muscle relaxers, and pain medication specific to your needs. You can also buy several supplements and over-the-counter medications; however, we want to make sure you are taking them. Stool softener, aspirin, iron, zinc, multivitamins, and selenium are commonly on the post-op medication list. Here are some other tips you may need for recovery.
We ask that you purchase fitted, post-op compression garments for your chest and buttocks, which run about $55.00 for the girdle and $30.00 for the bra. These compression garments can limit the amount of swelling and pain you may experience after the drains are taken out. You will find that the fitted bra and girdle are simple to put on and zippered to be easier to wear with an abdominal incision. We will give you a receipt for the garments so that you can put in a reimbursement claim with your insurance provider.
Time off for recovery
Dr. Spiegel will help you predetermine how many days/weeks you will need off for your surgery. Normally, we suggest that our flap reconstruction patients take a minimum of four weeks off. Women who work in physically demanding jobs should consider taking six or more weeks off for recovery. If you still need more time after the initial weeks requested, Dr. Spiegel can provide you with documentation that additional leave is necessary. We do not want you to injure yourself at work or make you exhausted.
Movement and activity level
Needless to say, you will not be driving for at least two weeks after your surgeries. If you are a smoker or live with someone who smokes, we ask that you refrain from all smoking or inhaling second-hand smoke for not shorter than six weeks of your recovery. If you do not follow this restriction, you may compromise your breast flap. You do not want this to be the cause of your surgery to fail.
You will want to work your way up to taking short walks and to not lift more than five pounds to start. Your upper body will have a limited range of motion for a while. Dr. Spiegel will assess your health at each follow-up appointment and make recommendations as to when you can resume lifting a heavier weight or going to the gym for exercise.
You will not be sleeping on your side or stomach for at least 3 – 4 weeks after your SGAP reconstruction. You can sleep in a recliner on your back and be elevated with two pillows. Once you are sleeping in your bed again, sleep on your back until after the eight-week mark.
Mammograms and self-exams after breast reconstruction
If your oncologist or primary care physician requests that you have a mammogram, schedule one as often as suggested. You can perform your own breast exams at home, too. You may not have breast tissue, but it is worth the time spent checking the area for any abnormalities in the skin and tissues for the health of your breast flaps.
SGAP Flap Our Support Group
Your emotional well-being matters to our team at Aldona J. Spiegel, M.D. Our emotional support group, "The Pink Sisters," meets several times a year with new, current, and former patients at our practice. Women in this group have been in your shoes or are going through the process as well. These breast cancer survivors can open up about their breast reconstruction stories in a compassionate setting. Not all information and recommendations you learn about at these meetings are medical! The shared experiences of this support group will show you that you are not alone in this situation.
Trust A Skilled Breast Surgeon
Our team at Aldona J. Spiegel, M.D. would like to extend a consultative appointment out to you for your breast reconstruction. Many women find that taking tissue from another ample area, such as the buttocks, is a better fit than the abdomen. Dr. Spiegel can help you discover the right procedure for your reconstruction after breast cancer. She has more than two decades of experience in providing this type of surgery to women in the Houston, TX area. When you meet for a consultation, she will wholeheartedly explain your options, answer your questions, and take into consideration how you want this procedure to unfold. We look forward to meeting you and walking this part of your cancer recovery journey together.