Septocutaneous Gluteal Artery Perforator Flap in Breast Reconstruction

  • Stefania TuinderEmail author
  • Ennie Bijkerk
  • René van der Hulst
  • Marc Lobbes
  • Arno Lataster


The first free flap breast reconstruction was performed using a myocutaneous flap from the gluteal region. Today, the abdomen is the first choice for the donor site. However, since not all women are eligible to undergo a deep inferior epigastric artery perforator (DIEP) flap, the gluteal region has been re-explored. The myocutaneous free flap underwent multiple technical refinements and modifications since it was first introduced. The most notable modification was the muscle sparing technique that transformed the myocutaneous flap into a perforator flap. In this chapter, the authors explain their technique, based on the superior gluteal artery perforators (S-GAP). Contrary to the original S-GAP flap perforators that run through the muscles (musculocutaneous perforators), the perforators used by the authors run in the septal plane between the gluteus maximus and medius muscles (i.e. septocutaneous perforators). This dissection of the septocutaneous perforators is easier and facilitates the harvest of the septocutaneous gluteal artery perforator (Sc-GAP) flap, compared to the standard S-GAP flap. The surgical technique is described along with several illustrative clinical cases.


Autologous Breast reconstruction Microsurgery Breast cancer Perforator flaps Septocutaneous perforators Superior gluteal artery 



We would like to thank Greet Mommen, medical scientific illustrator at Maastricht University, Department of Anatomy and Embryology, for the realisation of the illustrations in this chapter. Her ideas and active contribution were essential to help clarify and visualise the concepts as described above. We also would like to thank Paul van Dijk, histologic technician at the same department, for the excellent photography of the cadaveric dissection.


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Stefania Tuinder
    • 1
    Email author
  • Ennie Bijkerk
    • 1
  • René van der Hulst
    • 1
  • Marc Lobbes
    • 2
  • Arno Lataster
    • 3
  1. 1.Department of Plastic and Reconstructive SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
  2. 2.Department of Radiology and Nuclear MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
  3. 3.Department of Anatomy and EmbryologyMaastricht UniversityMaastrichtThe Netherlands

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