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While it often works well to transfer tissue from a woman’s abdomen for use in breast reconstruction, perforator flaps also can be taken from the buttocks (GAP), the underarm and back (TAP) or the inner thigh (TUG).
If you do not have enough tissue to spare from your abdomen to rebuild your breast, your surgeon can transfer tissue from your buttocks instead. Both types of GAP flaps take their names from the related blood vessel – the gluteal artery perforator. When the flap of tissue is removed, the incision is either made in the upper/superior region (sGAP flap) or lower/inferior (iGAP flap) region. Any scarring is easily concealed with underwear.
As with DIEP and other perforator flaps, the skin, fat, and blood vessel that make up the GAP flap are detached from the original site then attached at the mastectomy site and used to shape a natural, living breast with state-of-the-art microsurgical techniques. No muscle is transferred or damaged.
The anterolateral thigh flap – or ALT flap – is taken from the exterior of the thigh, above the knee. It can provide a large amount of soft fat and skin while sparing muscle.
The TAP flap is taken from the back and underneath the arm, so that your bra would hide any scarring. Because most women don’t have much tissue in that area, it is used more often for lumpectomy patients or as a supplemental tissue source for breast reconstruction. It may be used with small implants, too.
TAP stands for thoracodorsal artery perforator, the flap’s main blood vessel. As with other perforator flaps, skin, fat, and blood vessels are harvested for transfer, but not muscle. In contrast, one of the first breast reconstruction procedures, LD, involves transferring the back’s latissimus dorsi muscle along with the attached skin and fat.
The TAP flap is a versatile option. The surgeon can detach it as a “free flap” before transferring it or use a tunneling approach to move the flap under the skin from the upper back to the chest region.
The TUG procedure uses skin and fat from the inner portion of the upper thigh. The flap is named for the transverse upper gracilis muscle to which the skin and fat are connected. (The incision scar will be hidden near the crease of the groin.) While muscle may be removed as part of the TUG flap, the loss does not affect your ability to do daily activities. An added bonus of this surgery is an inner thigh lift.