Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 24:
Superior Gluteal Free Flap for Breast Reconstruction
  The superior gluteal free flap was first described by Fujino.21 Unlike regional flaps, the superior gluteal flap brings tissue to the area without borrowing functional tissue from an adjacent area (e.g., rectus abdominis, latissimus dorsi). Axillary dissection is minimal, reducing the possibility of lymphedema. There is a greater freedom of design compared with that of the regional flaps, which are restricted by their pedicles. The donor site is inconspicuous and lacks the potential for hernia formation or functional deficit that other techniques may suffer. Because the flap provides an ample breast mount, prostheses are not required. Psychologically, the patients regard the reconstructed breast as a part of their own body rather than one composed in part of a foreign implant. Owing to the free flap's independent arterial supply, future revisional surgeries, local resection for recurrent cancer, and postoperative radiation are all possible. Breast reconstructions using Shaw's 22-24 modification of the superior gluteal free flap shows that excellent results can be achieved in most patients, and that the technique fulfills the requirements of an ideal reconstruction. These criteria are:

1. Simple concept-transfer of an autogenous block of vascularized skin and muscle.

2. Limited and defined operations over a short period of time, usually consisting of one operation with smaller refining procedures.


3. Permanency: the flap is a living part of the body.

4. Restoration of contour and softness.

5. Minimal donor site disFIGurement or functional loss.

Among the principal disadvantages are the specialized training and equipment needed, but as microsurgery becomes more common, this problem is diminishing. The length of the procedure is longer than for breast reconstruction with implant or a regional flap, and with increased experience, the operation can be performed in about 7 hours. Given the excellent results and the flap's advantages, this longer operative time is well spent.

The superior gluteal flap is not suitable when skin grafts have been used to cover large areas of the upper half of the mastectomy defect. In these instances, the rectus abdominis flap may offer a better solution. In most cases, however, mastectomies have been closed primarily, and the superior gluteal flap technique can be used.

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