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Perforator flaps are flaps of skin and fat with an artery and vein for blood supply.
When creating perforator flaps no muscle is taken, so, if the flap is taken from the abdomen, there is much less chance of weakness or hernia. Most perforator flaps are free flaps. The operation takes about 6–8 hours or more to do and you’ll need to stay in hospital for about a week or longer. It may not be a suitable operation for women who are diabetic, heavy smokers, very overweight or who have had previous abdominal surgery.
There is a chance that the tissue in the area may die if the blood supply to the new breast isn’t good enough. This happens in up to 5% of women who have these procedures. Our information about possible complications after breast reconstruction| describes what happens if tissue dies.
There are several types of perforator flaps. They are named after the blood vessel that is used.
Free DIEP flap (deep inferior epigastric perforator flap) or the free SIEA flap (superficial inferior epigastric artery flap). Skin and fat is taken from the lower abdomen. The tiny blood vessels that keep the skin and fat alive are very carefully cut out from the muscle, which is left in the abdomen. The appearance of the new breast is usually very good and feels very natural. As no muscle is taken from the abdomen, the risk of hernias or bulges is almost completely removed, so a mesh isn’t needed.
Free SGAP flap (superior gluteal artery perforator flap) or the IGAP flap (inferior gluteal artery perforator flap). This uses fat and skin taken from the upper or lower buttock to create a new breast. It is generally used when abdominal tissue can’t be used due to scarring from previous surgical procedures or because the woman is too slim. The breast produced from the IGAP flap is softer than the one from the SGAP flap. Also with the IGAP flap, larger breast sizes may be created, and the scar easily hidden by underwear because it is in the buttock crease.
In rare cases, it may be possible to take free perforator flaps from other places, where there is enough fat and a suitable blood supply.
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