SIEA, SGAP, and TUG Flap Breast Reconstruction

The SGAP, SIEA, and TUG Flap procedures are all effective avenues of treatment for women in need of breast reconstruction following a mastectomy or injury.

The SGAP Flap procedure is designed to take tissue from the buttock region to form the new breast mound, and requires significant microsurgical experience from highly-trained reconstructive surgeons. The SIEA Flap breast reconstruction procedure is very similar to the DIEP flap procedure, as it involves the same area of skin in the abdominal region that the tummy tuck procedure is designed to remove and tighten; however, in the SIEA Flap procedure, the surgeons at New York Plastic Surgical Group, a Division of Long Island Plastic Surgical Group use the blood vessels in the fatty abdominal tissue, instead of tunneling the blood vessels within the muscle as the DIEP Flap procedure employs. The TUG Flap procedure is designed for patients that may not have enough skin and tissue in the abdominal or buttock region to create a successful breast mound. Instead, the TUG Flap procedure involves a process similar to the SGAP or SIEA Flap procedures, but uses skin from the patient’s inner thigh to create the breast mound. Each of these breast reconstruction procedures serve as good alternatives for women who may not be candidates for other techniques such as implant reconstruction.

SIEA Flap Breast Reconstruction

Similar to a DIEP Flap surgery, SIEA (Superficial Inferior Epigastric Perforator) Flap breast reconstruction takes donor tissue from the abdominal region to form the new breast. Skin and fat from the abdomen is moved to the breast area, with blood vessels microsurgically reattached to create a new blood supply to the reconstructed breast. After this is achieved, the donor skin will be reshaped to form the new breast.

As with a DIEP Flap procedure, the SIEA Flap technique also results in a form of tummy tuck. The remaining skin from the donor site in the abdomen will be lifted and tightened for a more toned appearance. A main difference from the DIEP Flap procedure is that the blood vessels in the fatty tissue are used in the SIEA procedure, as opposed to the DIEP procedure, which tunnels the blood vessels below and within the abdominal muscles.

Similar to the SGAP Flap surgery, an advantage of the SIEA Flap breast reconstruction procedure is that the surgeons can avoid removing muscle from the abdomen, which typically results in less pain during recovery, and a decreased risk of developing hernias.¹

SGAP Flap Breast Reconstruction

SGAP (Superior Gluteal Artery Perforator) Flap reconstruction surgery involves taking skin and tissue from the top of the buttock and relocating it to the breast area, which is beneficial for patients who do not have enough tissue in the abdominal region to provide donor skin for the breast reconstruction procedure. One of our NYPS Group reconstructive surgeons will microsurgically reconnect the artery and vein from the donor tissue to its new placement on the chest, which establishes a new blood supply to the donor tissue, and allows the surgeon to then reshape and mold the skin and tissue to form the breast mound.

A secondary benefit of the SGAP Flap surgery is that in addition to breast reconstruction, the process of taking donor skin from the buttocks results in a buttock lift. In addition, this procedure does not utilize muscle in the relocation of tissue, which can provide a more comfortable recovery after surgery.²

TUG Flap Breast Reconstruction

The TUG (Transverse Upper Gracilis) Flap procedure can be an effective option for patients who have had a previous tummy tuck or buttock lift, or for patients who are very thin and/or athletic, and simply do not have enough skin and fat to accommodate the SGAP or SIEA Flap procedures. The TUG Flap procedure, also known as an inner thigh breast reconstruction procedure, takes skin and muscle from the inner thigh and transfers it to the chest to create a new breast mound. The shape and composition of the donor tissue allows for very effective natural-looking results, as it creates a greater potential for fat sculpting when compared with the DIEP, SGAP, or SIEA Flap procedures.

Although TUG Flap surgery utilizes muscle from the thigh, there is not a significantly increased risk of developing hernias as with procedures that utilize a portion of the abdominal muscles, and typically provides patients with results similar to a thigh lift.³

¹ BreastCancer.org. SIEA Flap. Available: https://www.breastcancer.org/treatment/surgery/reconstruction/types/autologous/siea. Accessed October 27, 2020.
² BreastCancer.org. SGAP Flap/Hip Flap. Available: https://www.breastcancer.org/treatment/surgery/reconstruction/types/autologous/gap. Accessed October 27, 2020.
³ BreastCancer.org. TUG Flap. Available: https://www.breastcancer.org/treatment/surgery/reconstruction/types/autologous/tug. Accessed October 27, 2020.

The Doctors at New York Plastic Surgical Group have either authored or reviewed and approved this content.