Igap or Sgap reconstruction?

Hi, have any of you had an Igap or Sgap type of reconstruction or are considering it?
I have had a tissue expander in but the valve failed so it was removed and a small implant was put in where the skin had been stretched - on my ‘good’ side I was given an implant and an uplift so both boobs matched but I have ended up with a B cup on the BC side and a D cup on the good side so I am very visibly lop sided. My surgeon was happy to leave me like this as my stomach was too flat to use and I refused to let him use my back muscle and skin as I swim/cycle and hike regularly and didnt want to risk losing any movement or strength. I looked into the other options and am meeting with another surgeon tomorrow to discuss an Igap or Sgap flap (buttocks) and just wondered if anyone had any info or experience of these types of ops themselves?


Hi Clarabelle

I am about to see another PS to discuss my suitability for (hopefully ) an IGAP or at a push an SGAP reconstruction. My surgeon has referred me as he only has the facilities at his hospital to do LD flaps or TRAM flaps. I can’t have an LD flap and would rather have an IGAP over abdominal surgery. From what I gather not many surgeons perfom this type of reconstruction as it is highly specialised and there is a flap failiure rate. I don’t know what the failiure rate is. Where in the country are you as there are no surgeons in my area offering any form of buttock surgery?


Hi Corinne,

lucky you to be seeing Elaine - have you not seen her book ‘The Boudica Within’ ? it is absolutely brilliant with real woman telling their story and photos of their recons.
(Bought my copy from Amazon) She is THE surgeon to have for this type of op if you are a good candidate and wish to proceed.

I went to see my new plasic surgeon yesterday and he has said that I am not a good candidate as through exercise I have a very firm bum so not enough spare skin to use but we did speak in depth about it and to be honest I dont think after knowing more that I would have it done by anyone other than Elaine. I am in the West Midlands and he did say if I was insistent on having it done that he could refer me on to her but I declined at this stage.

It is a very difficult op as it is micro surgery and sometimes the flap fails leaving you with a bit missing from your bum and still no boob. If it does take it is not easy to mould into a good shape as the buttock skin is tougher/thicker than other skin and also (you may not have thought of this) - the buttock skin can be quite hairy! so not a good look lol!

All that said, if I was near to Elaine who has really mastered this type of recon then I would be confident she would do a good job and wouldnt hesitate if she said it was possible. Her being female is an added bonus too as I think some male surgeons dont realise how important it is to us to get a good match!

So, I am back in next Thursday for a third tissue expander to hopefully stretch the skin from a B to a D to match them up - if he cant get a D then we will look at reducing the D cup so watch this space - I will let you know how I get on. If I am still not happy with the result then I will think again about using the buttock but while there is still an option open to use the breast skin then for me that is the best way forward.

I have a photo diary of all of my procedures which I will put on the web once it is completed as I couldnt find many ‘real’ peoples photos and I think it would be helpful to others to see what you really look like at each stage.

Please let me know how you get on and what you decide to do.


Hi Clarabelle

Lucky you being able to have implants. I have been advised against implants as I had radiotherapy and scar tissue can contract around the implant and distort it and then it would need to be removed. I am having problems with scar tissue at the moment and I haven’t even started down the recon road yet. Implants would be the perfect option as far as I am concerned but unfortunately I can’t have them.

Yes I had already thought about the difference in buttock skin. My husband suggested a tug flap (where tissue is taken from the inside of the thigh) but I have my thighs waxed and I wouldn’t fancy waxing my new boob somehow - LOL. After losing all my hair during 6 months of chemo it has all come back with a vengance and I now have hairs where I didn’t before. But you are right that this is something to consider. I have read that the reason that DIEP’s are so popular is because the skin on the tummy closely resembles breast skin and gives a more natural look and feel. I am very much a bikini girl and don’t feel I could accept such a big scar on my tummy so IGAP would be an easier compromise for me. However I might be told that I too am not a suitable candidate for this as I do a lot of exercise.

How long will you be in for on Thursday and how long does this procedure take ?

Speak soon. xxxx

Hi Corrine,

On the two previous occaisons I have been told to expect to be in for two nights but both times I have managed to escape/be discharged after just one night.
They like to keep you in until any fluid has drained off and the drain is removed but I dont seem to have any fluid to drain so have been let out early!!
Hopefully it will be the same on Thursday. The actual procedure only takes about an hour to put the expander in but you then have to go back to have it inflated with saline over a number of weeks/months depending on what size you are trying to get to.

I too am a bikini girl and also did not want more scars all over the place which is why I opted for the expander followed on with an implant.

Did you have to have radiotherapy? I was offered it but asked if it was vital and was told no so I opted not to have it purely because I knew if I had it, like you, it limits the type of reconstruction you can have. And boy does it annoy me how many girls/woman have it without questioning it. Same goes with taking Arimidex - the side effects are far worse than not taking it so again I refused it. I had a mastectomy, had my ovaries removed and reluctantly had the chemo to sweep up any rogue cells as I was a grade 3 most aggresive and absolutely believe that these toxic drugs do more harm than good - in fact I questioned the risks of the chemo and was told by my oncologist that the drugs used are in fact carcinogenic!!

I hope you get what you want in the end and will post next week when I have returned from hospital.

Take care