Steven J Kronowitz1. 1. Houston, Texas From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center.
Abstract
BACKGROUND: The standard elliptical gluteal artery perforator (SE-GAP) flap is an alternative to the transverse rectus abdominis myocutaneous flap in patients undergoing breast reconstruction. However, many experienced surgeons find use of it technically difficult, and the complication rate is high. The author investigated whether a redesigned gluteal artery perforator (R-GAP) flap is more reliable than the SE-GAP flap for breast reconstruction. METHODS: The author retrospectively reviewed the records of 12 patients with 13 reconstructed breasts: four underwent unilateral SE-GAP flap reconstruction, one underwent bilateral SE-GAP flap reconstruction, and seven underwent unilateral R-GAP flap reconstruction. All patients had their information entered prospectively into a clinical database and were followed longitudinally. Differences between the reconstruction options were assessed using a two-sided Fisher's exact test. RESULTS: The complication rate was higher with SE-GAP flaps (67 percent) than with the R-GAP flaps (29 percent). Recipient-site complication rates were 50 percent with SE-GAP and 14 percent with R-GAP flaps; donor-site complication rates were 17 percent with SE-GAP and 14 percent with R-GAP flaps. Cosmetic outcomes were worse with SE-GAP flaps: there was insufficient volume to achieve the desired breast size in 83 percent of SE-GAP versus no R-GAP flap reconstructions (p = 0.0047); the reconstructed breast had an irregular contour in 67 percent of SE-GAP versus no R-GAP flap reconstructions (p = 0.0210); and a major revision of the reconstructed breast was required in 50 percent of SE-GAP but no R-GAP flap reconstructions (p = 0.0699). CONCLUSIONS: The R-GAP flap is more reliable than the SE-GAP flap and permits successful reconstruction of larger breasts. Surgeons should consider incorporating R-GAP flap breast reconstruction into their clinical practices.
BACKGROUND: The standard elliptical gluteal artery perforator (SE-GAP) flap is an alternative to the transverse rectus abdominis myocutaneous flap in patients undergoing breast reconstruction. However, many experienced surgeons find use of it technically difficult, and the complication rate is high. The author investigated whether a redesigned gluteal artery perforator (R-GAP) flap is more reliable than the SE-GAP flap for breast reconstruction. METHODS: The author retrospectively reviewed the records of 12 patients with 13 reconstructed breasts: four underwent unilateral SE-GAP flap reconstruction, one underwent bilateral SE-GAP flap reconstruction, and seven underwent unilateral R-GAP flap reconstruction. All patients had their information entered prospectively into a clinical database and were followed longitudinally. Differences between the reconstruction options were assessed using a two-sided Fisher's exact test. RESULTS: The complication rate was higher with SE-GAP flaps (67 percent) than with the R-GAP flaps (29 percent). Recipient-site complication rates were 50 percent with SE-GAP and 14 percent with R-GAP flaps; donor-site complication rates were 17 percent with SE-GAP and 14 percent with R-GAP flaps. Cosmetic outcomes were worse with SE-GAP flaps: there was insufficient volume to achieve the desired breast size in 83 percent of SE-GAP versus no R-GAP flap reconstructions (p = 0.0047); the reconstructed breast had an irregular contour in 67 percent of SE-GAP versus no R-GAP flap reconstructions (p = 0.0210); and a major revision of the reconstructed breast was required in 50 percent of SE-GAP but no R-GAP flap reconstructions (p = 0.0699). CONCLUSIONS: The R-GAP flap is more reliable than the SE-GAP flap and permits successful reconstruction of larger breasts. Surgeons should consider incorporating R-GAP flap breast reconstruction into their clinical practices.