The In-The-Crease IGAP (Inferior Gluteal Artery Perforator)
Our newest development, the In-The-Crease I-GAP Flap,
is an excellent option for many women. Excess skin and fat are borrowed
from the inferior buttock, leaving an improvement in buttock shape,
and a scar that is almost completely hidden. For women
requiring bilateral reconstruction both the SGAP and the IGAP
can be performed as a bilateral simultaneous operation, so
that only one operation is needed to reconstruct both
Until recently, the GAP flaps have been our second choice of donor
site, reserved for patients who were not candidates for the use
of abdominal tissue. However, we have found that, for many women,
the best of all cosmetic results comes from harvesting
skin and fat from the inferior buttock. The scar ends up
within the buttock crease, and is almost imperceptible,
and the patient has a tighter, lifted buttock. " The scar remains
in the crease and does not migrate inferiorly over time as was the
case in some cosmetic buttock lift procedures of the past. This
recent realization has led us to consider the In-The-Crease I-GAP
a first choice in many cases. See
The In-The-Crease IGAP is harvested using the same microsurgical,
muscle-sparing techniques as the DIEP, SIEA and SGAP flaps. The
advantage is that there is almost always adequate volume
to make an appropriate sized breast, the donor site is often improved
by the operation, and the scar is completely concealed within
the inferior buttock crease.
Older operations that used the lower buttock took both fat and
muscle. Despite the excellent cosmetic results, this operation
was abandoned because of occasional problems with the sciatic nerve
in the back of the leg. By taking only the skin and fat and leaving
the muscle undisturbed, injury or exposure of the nerves is
not a problem. The nerves run underneath the muscle and are
completely protected by it.
Excess tissue is taken from the lower buttock to create a new breast.
Ample tissue is always left for comfort when sitting. Patients
report no problems with sitting postoperatively. In fact
many of the IGAP patient have remarkably little or no pain.
|Examples of Final Results - Post
An advantage of the IGAP is that the aesthetic shape of the upper
buttock is preserved.
The final result of the reconstructed breast is comparable to that
of the SGAP. Deciding on the SGAP vs. the IGAP depends on patient
preference and anatomy, how much tissue the patient has to donate
from each site, and preference for scar location by the patient.
Restoration of the nipple and areola follow. For many women the
reconstructed breast may be firmer and have a more youthful appearance
than their natural breasts. Women with ample buttock tissue, sagging
buttock, or sparse abdominal tissue are ideal candidates.