Application and refinement of the superior gluteal artery perforator free flap for bilateral simultaneous breast reconstruction.

BACKGROUND The gluteal artery perforator free flap represents the state of the art in autogenous breast reconstruction for the patient with insufficient abdominal donor tissue. Preservation of the gluteal musculature limits morbidity and allows for rapid patient recovery. The need for intraoperative repositioning has historically limited gluteal artery perforator flap breast reconstruction to one breast per operation. This results from a desire to avoid marathon surgical times when the flaps are dissected out sequentially and/or having the patient lie on the first reconstructed breast as the second flap is harvested. Prior protocols have relied on staging the reconstructions weeks apart to address these concerns. This is a significant issue for patients requiring bilateral mastectomy and results in the patient being subjected to two major sequential operations and their associated recoveries. METHODS The authors describe their experience and associated technical considerations with an initial 20 patients (40 flaps). RESULTS The average operative time was 7 hours 47 minutes (excluding mastectomy). There were no vascular complications and no flap failures. CONCLUSIONS Bilateral simultaneous gluteal artery perforator flap breast reconstruction may be performed safely with reproducible success and a complication rate that is comparable to that of other commonly performed autogenous tissue techniques. This report represents the largest described experience to date and the first dedicated treatise on a protocol that provides significant advantages and an option that has heretofore been unavailable to this group of patients.