SGAP
Superior Gluteal Arterial Perforation

When I was diagnosed with BC I knew I wanted an immediate reconstruction. As a very small breasted 34 AA I had always been self-conscious and the idea of having only one boob was something I simply couldn’t handle. I didn’t know anything about options and types of reconstruction then. All I knew was I wanted rid of the boob but I didn’t want to wake up with nothing.

Because I was so small it was agreed that I would have an implant on the good side too – this would provide the opportunity to achieve balance. The implants were expanding ones that seemed fine immediately after the op. They had agreed I was an ideal candidate for implants because of my relative size and the fact I would not need radiation therapy.

Sadly they had found a second tumour close to the chest wall, which meant I did need rads after all. This caused the implant to harden and it became very painful so the surgeon offered to replace it. There was only one possible reconstruction for me – they say I’m too thin for the other types – so it was SGAP or nothing, Superior Gluteal Artery Perforator – a lump of fat and skin from the top of the buttock is removed with blood supply and stitched into place as a breast. It wasn’t an easy decision to make. I have many misgivings about my body but my bum was never a problem – one of my better features and here I was considering having a lump taken out of it. But I met a lady who had bilateral SGAP recons and the results were so good I was sure it was the right thing. There wasn’t a huge amount of detail on the web – check out some of the American sites – and I couldn’t find many people to talk to on my preferred web sites. Seeing the “real” thing was great and I’m so pleased that lovely lady allowed me to look.

It seemed to take forever to reach the day of my operation. And when it arrived I was petrified. In tears and shaking. The lot. And that simply isn’t like me.

I had to report to the admissions ward at 7.30 of the morning of the designated day (Tuesday 28th August 2007). I wasn’t kept hanging round long – got moved to the plastic surgery high dependency ward within minutes and ended up in the same bed as I’d been after my mastectomy.

There was a queue of surgeons nurses and anaesthetists all waiting for me with pens to draw on me and papers to be signed – admissions had forgotten to tell me to turn up the day before! My eldest son had come with me and we walked to the theatre together. I said bye to him at 9 am. Woke up on ward at 11.20 pm. Surprisingly I have no memory of being woken in the recovery room. I felt like a bus had hit me.

I had two drains – a boob one and a bum one. I had morphine drip and saline drip. I had pressure boots to help prevent DVT. I had a catheter. I wasn’t allowed to move. They kept me lying flat for about 36 hours with only sips of water because there was a high chance I would have to go back to theatre – but I didn’t need to. One odd memory is of the physio visiting on Wednesday to check movement – at the time I thought it was very soon. One even odder and unexplained memory is of a number of people being in the corner of the room. Only it wasn’t the room I was in and they weren’t nurses. For some reason these people were determining my future. I guess it was a dream but it left me with an odd and slightly uncomfortable feeling.

I slept a lot drifting into the real world briefly for medicine and when they checked the flap. There are 3 sounds to listen for but the one that indicates things are ok is the one that is a rhythmic rushing sound, which is the blood flowing and it means the flap is healing. Drips came out marking the passing of time and the fact that I was improving. By Thursday I was able to munch a little toast – but that’s not easy lying down.

I was fitted with a sports bra – size 38B (obviously pretty swollen – I’m a 36 B now). Once I had the bra I could sit up. Later that day I was asked to get up. By Friday I was down to a single drain and all the other stuff was gone. I was walking to the end of the corridor, showering and complaining about the heat. Believe it or not they brought a heater in to warm things up for another patient to join me. It was melting in that room. My lovely consultant arranged to have me moved to a cooler ward so I had company and met some nice people including a 20 year survivor of BC.

Saturday I walked off the ward to the hospital shop for ice cream. Sunday I went home. That was nearly a miss but again my consultant rescued me. I still had the drain until he turned up and insisted it be removed – they all jump when he’s around!

Seems remarkable that I went from flat out on Wed to cooking a meal and walking the dog on Sunday – but I did. I’m sure this is mainly due to the nature of the operation, which is long but doesn’t involve any muscles. I had read that healing times are reduced with the SGAP and I’m delighted to prove this right.

The hospital staff were excellent and really interested in the surgery and results.

They really looked after me and without them I’m sure I would have recovered more slowly. The result of the surgery is good and I’m very happy. I’m already on the list for the fine tuning which in my case is a replacement for the implant under the good boob for fixed volume silicone one and a new nipple. I returned to work after 7 weeks and feel really well.

I didn’t find it too easy to locate good web pages or sources of information about the SGAP but I have recently noticed this site shows one set of good pictures

http://www.mdanderson.org/Diseases/BreastCancer/reconstruction/

Go to the tissue based reconstruction bit then select breast reconstruction with alternative flaps and scroll down for a graphical representation of the op plus pictures.

If anyone wants to know more – I’ll be happy to answer pms from members.