SGAP decisions

Hi,

I'm so glad you asked this question about the SGAP surgery, and I hope others who have had this less common tissue transfer reconstruction will chime in with information and feedback. I've got an implant that failed (after 6 years), and with too little belly fat, my PS has also suggested the SGAP. I trust my PS and know he's extremely experienced in all of these surgeries, but I'm terrified to undergo the surgery, which is scheduled for July 23. I did try asking a while ago for info from any other women on BCO who've had this, but I didn't get much response. On the plus side, I always hated the implant, even before it failed, and the tissue transfer is supposed to feel much more natural. If I'm left with a noticeable dent in my buttocks, the PS will do fat grafting. My greatest fear is that the grafted flap will fail, and I'll be left with a dented rear end and a flat one-sided chest. But I'm not sure what else to do, the failed implant needs to come out, so I guess I'll go ahead with it. I'll make sure to post my experience on here for others to receive feedback

I had a unilateral DIEP and then went back 4 years later for prophylactic ns sGAP on the other side. The reconstructions are my own tissue and just feel like "me." Feel free to PM me if you like. As cascader said there are many women on the NOLA in September thread and Charleston threads with sGAP reconstructions.

When it comes to sGAP reconstruction or lumbar flaps (a slightly higher donor site) make sure you have someone who does this in high volume. When I checked in the DC metro/ Baltimore area I did not find anyone who did this specific surgery more than about 15 times a year. I traveled to NOLA because the physicians there do hundreds/year. I am happy with my outcome.

There are also ps who can "stack" a DIEP reconstruction - connecting blood vessels to use both sides of the abdominal flap which can sometimes offer a thin woman the option of using this donor site. Again you may need to travel to find a p/s who is able to do this specialized surgery.

(The topic of fat grafting and sGAP reconstruction was addressed on Dr. Dellacroce's (a NOLA docs) web site- see link below. Just one ps's experience to consider.)

http://members.boardhost.com/plastic/msg/134335709...

Just reporting back in after having my SGAP surgery on July 23rd. The procedure literally and figuratively kicked my butt. A 10 hour surgery, followed by a second operation 2 days later in which all of the incisions were re-opened again on account of too much bleeding. But I'm now 3 weeks out, still in a lot of pain, but hopefully moving forward. I tire incredibly easy, but do go on short 20 minute walks a couple of times a day. The incisions on my chest and my buttocks seem to be slowly healing. Much of the pain is from my rear end. It's absolutely impossible to sit or lie down without putting pressure on the incision, which goes clear across the cheek. The new breast does already look much better than the reconstruction I originally had with the implant, which failed due to capsular contracture. Can't say yet whether I'd highly recommend this SGAP surgery. If in another month or so I'm pretty much healed and feeling more like myself, I'd say a definite "yes," but for now, it was an incredibly major, and painful, surgery to go through, so still doubting myself whether or not it was a good idea.

Since there are so few women on BCO who get SGAP, I did want to share my experiences for others to follow, in case anyone else was interested in the SGAP.

Just a note to Besa, I did receive your PM, but every time I try to respond, it says I'm blocked and you no longer receive PMs. So I apologize if you think I'm rude and haven't responded to you, but BCO isn't letting me! Hope you're well.

Digger, just reading your post has been so helpful. I am going to be having surgery hopefully in next month or so, but am torn on whether to have SGAP or DIEP. My PS says DIEP is his first choice as it not as lengthy of a surgery, still tough, but less time under anesthesia, but I don't have a lot of excess abdominal tissue and the results will be a very small B if even that, and on my breast that underwent radiation and lumpectomy, PS says I'll probably need an implant in addition to flap to give the breast volume-I was trying to avoid implants altogether but may not be able to. And then there is always the recommended latissmus dorsi flap recon, but I am thinking muscle sparing is a better option? I know you are still in the process of healing, but do you feel happy so far with the results, both the breasts and the buttock area post op? Do you feel that you will eventually be able to resume your usual activities? I'm a weekend runner and aerobics girl and wondering if SGAP limits mobility for good or just while healing as in for a few months. Anyone that has had either or both types of procedures, I would appreciate any information you have as these are some of the toughest decisions I have ever faced.

Well, it's been a while since I last reported in, and I'm now about 6 1/2 weeks out from unilateral SGAP surgery. Most of the worst pain is gone now, the breast and rear still hurt a bit, but definitely tolerable. I'm back in a regular bra and my skinny jeans, moving a little slower than usual, but feeling good. My reconstructed breast looks very good to me, a couple of hard spots, hopefully that's okay and not necrosis. My rear is definitely smaller than the other cheek, but in my skinny jeans, my husband promises you wouldn't notice. Unclothed, the donor side of my rear is most definitely smaller and flatter, and the scar reaches across the entire cheek, but I'm okay with it. I don't think I'm going to do anything else with that cheek, I know some people would do fat grafting from elsewhere on the body to fill in the flatness, but I'm okay with it. I see my PS next week for a check up, and hopefully will get the all clear to engage in more aerobic exercise. For now, I'm walking a couple miles a day to make sure I don't lose too much muscle. I am starting PT this week to help with my range of motion on the arm affected by the reconstruction. All in all, I'm pleased with the SGAP, much happier than I was with the implant. I expect to be back on the ski slopes by the winter, so that's great! I know that there are risks involved with any of these flap surgeries, but hopefully I'm past the worst of it. If, for some reason, I'm faced with losing my other breast, I would probably opt for another SGAP, even though it's a really, really tough surgery and recovery. If it works, it's permanent. Please feel free to ask me any other questions, I'm happy to help.

Thanks so much for all the great information, it helps to hear real stories more than any amount of information you can read about all the different surgical options for recon. I am still working through insurance issues, and still vacillating between DIEP and maybe LSGAP when I finally approach my surgery date. I have heard so many differing opinions and this is truly one of the most daunting decisions I have ever had to make, but for me, I think LSGAP or SGAP may be the best as my rear is where most of my excess tissue is, but from what I understand this is the lengthier surgical choice, more hours in the OR, maybe 2 separate surgeries instead of one, so what a tough choice. Again, thanks to all the wonderful women who share their stories, this site is truly a blessing for those of us faced with so many difficult situations and choices.

Steelersluver- for whatever it is worth, this is just my take on things. How I personally made my decisions about who I wanted to do my sGAP surgery and a little about my take on a bilateral sGAP reconstruction if that is what you want. I hope this post is not too long...

I ruled out the microvascular ps at Hopkins. Compared to other options in the area -to me they seemed to be young, stayed for a relatively short time and then moved on. I considered two other ps in the DC/Baltimore metro area - Bernard Chang at Mercy and Nahabedian at Georgetown. (Both Chang and Nahabedian had worked at Hopkins and then moved on.) At the time I asked (2011 -2012) both Bernard Chang and Maurice Nahabedian were doing about 15 GAPs/year.

Bernard Chang at Mercy would have been my first choice if I had had the surgery done locally. He did not seem to do nipple sparing (which was what I wanted- my sGAP was prophylactic.) Though it was not relevant to me I don't think Dr. Chang does bilateral sGAP reconstructions so going to him for a bilateral reconstruction might require two stage I surgeries. (As an aside, my understanding it that there is a microvascular breast reconstruction fellowship program at Mercy.)

The other option was Nahabedian at Georgetown. He had done some revisions for me on my (on a very problematic DIEP side- DIEP was done locally in Maryland). I felt he was sometimes rushed when dealing with me. I had had a previous reduction on the future GAP breast. Dr. Nahabedian told me that nipple sparing was not possible because of the reduction- the nipple would surely die. I think Dr. Nahabedian does do bilateral sGAP reconstructions - but because of the length of the surgery I am guessing his surgical residents might be playing a relatively big part in a bilateral reconstruction.

II did not research the Philly sGAP ps. If I was gong to travel I decided it would be to NOLA.

I knew the NOLA docs were doing multiple 100s of GAPs/year and I knew they were doing nipple sparing on previous reduction - generally without a problem. At NOLA I would have two senior very experienced ps working on me at the same time - so my time in the O.R. would be shorter. There would be no residents or fellows participating in my surgery. Generally the woman who had used these docs gave them rave reviews and two separate physician friends who were helping me with this research independently recommended them. I had a negative experience with my local DIEP reconstruction in Maryland. My DIEP side, and this ps's work on my contralateral side for "symmetry" required many revisions.(Turned out the ps was very well trained but had done few DIEPs after finishing training.) I was willing to travel to stack the cards in my favor. For me NOLA turned out to be a good decision.

So just my personal feeling about things...

Digger, I am not sure if you are still on the message boards but would be curious how you are doing now? I had an SGAP in 2008 and starting to have pain in my buttocks now. Wondering if this is normal for those years out?

Thanks,

Jen