The abbreviation stands for “ Superior gluteal arterial perforator flap ”. The gluteal region refers to the buttocks where similarly to the DIEP procedure, the blood vessels perforate the muscles so that a skin and fat unit can be removed without causing damage to the underlying musculature. The S-GAP procedure is a microsurgical breast reconstruction that provides enough volume , using the body’s own tissue, for the creation a new breast mound. Similarly to the DIEP procedure, blood vessels from the donor site will be, through the use of a surgical microscope, sought after until an artery (carrying oxygen-rich blood) and a vein (carrying oxygen-poor blood) are isolated . Finally the tissue and its vessels will be harvested and extracted and the buttocks tightened in the sense of a buttock-lift. In rare cases an asymmetry of the buttocks can occur with the need of a following buttock-lift of the opposite side. The scars produced are not noticeable since the surgical cut is made in a diagonal manner exactly where the underwear are being worn. The S-GAP offers similarly to the DIEP procedure , a tissue consistency very similar to that of the natural breast. A microsurgical suture of the donor vessels to the systemic circulation is important so that the flap is kept well perfused and warm. The donor vessels are connected with an artery and a vein of the chest that run behind the rib cage. This can be achieved either be creating a small window through a rib or simply between the ribs. In our Clinic for Plastic Surgery in Berlin, which specialises in the field of microsurgery, the operation in the hands of our experienced microsurgeon and a well trained team lasts about 6 hours. Risks and limitations are like with other breast reconstruction procedures possible. After the breast reconstruction, our experienced team in Berlin is always at your disposal so that possible complications can be detected at an early time and unwanted complications avoided. For this reason the patient is kept for supervision in the intensive care unit during the first postoperative day. Rarely a hematoma can occur at the donor site after the harvest of the graft which is usually self-absorbed. If not , it is surgically removed under a short anaesthesia. Such an after-bleeding can similarly occur at the recipient site where the flap was transplanted, with the possibility of a necessary following surgical removal of the hematoma. When enough tissue on the buttocks is available, then the reconstruction of the desired breast mound is possible. In rare cases where the donor tissue is not sufficient enough to reach the size of the opposite breast, a symmetry can be achieved through a breast lift of the opposite breast at a later time. The whole strategical approach though needs to be clarified and explained to the patient for her own orientation. Altogether the buttock area is an exceptional donor area that can lead to a natural and long lasting result.