Choosing a breast reconstruction technique after mastectomy is not a cosmetic decision: it is a critical medical choice that affects how your body functions, feels, and heals for the rest of your life. The flap you choose determines not only how natural your reconstructed breast looks, but also how your donor site recovers and how well the results age with you over time.
At the New York Group for Plastic Surgery, this decision is never rushed or generalized. Our surgeons evaluate your anatomy, medical history, lifestyle, and long-term goals to guide you toward the safest and most effective option. Understanding how each flap works and who it’s truly right for puts you in control of your reconstruction journey.
DIEP flap breast reconstruction
The DIEP flap (deep inferior epigastric perforator flap) uses skin and fat from your lower abdomen to create a new breast, while fully preserving the abdominal muscles. During surgery, tiny blood vessels that supply the tissue are carefully dissected and reconnected to vessels in the chest using microsurgical techniques. Because the muscle remains intact, this approach maintains abdominal strength and reduces the risk of hernias or long-term core weakness.
The DIEP flap is ideal if you have sufficient lower abdominal tissue and want a soft, natural breast that behaves like real breast tissue. Many patients appreciate the added benefit of a flatter abdomen, similar to that achieved with a tummy tuck. This is especially well-suited for active women who want durable results without sacrificing physical strength.
SIEA flap breast reconstruction
The SIEA flap (superficial inferior epigastric artery flap) is similar in appearance to the DIEP flap but differs in how the blood supply is obtained. Instead of dissecting deeper abdominal vessels, the surgeon uses superficial blood vessels that run just beneath the skin. This allows the tissue to be transferred without entering the abdominal muscles or fascia.
This flap can offer an even gentler recovery for the right candidate, but not everyone has blood vessels that are strong or consistent enough to support it. The SIEA flap is best for patients with adequate lower abdominal fat and favorable vascular anatomy. A detailed preoperative evaluation is essential to determine if this option is feasible and safe for you.
PAP flap breast reconstruction
The PAP flap (profunda artery perforator flap) uses tissue from the back of the upper thigh to reconstruct the breast. Skin and fat are harvested while preserving the thigh muscles, and the tissue is transferred to the chest with microsurgical precision. The incision is typically placed along the natural crease beneath the buttock, helping keep scarring discreet.
This option is particularly well-suited if you do not have enough abdominal tissue or have had prior abdominal surgery that limits your options. The PAP flap provides excellent projection and shape, especially for women with lean builds. If you want to avoid abdominal surgery altogether while still achieving natural, long-lasting results, this technique may be an excellent fit.
SGAP flap breast reconstruction
The SGAP flap (superior gluteal artery perforator flap) uses skin and fat from the upper buttock without removing muscle. The tissue is carefully shaped into a breast mound, and blood vessels are reconnected using microsurgery. Because the donor site is the buttock, the abdominal and thigh tissues are left largely untouched.
This is ideal if you lack sufficient tissue elsewhere or want to preserve both abdominal and thigh contours. It is a demanding procedure that requires a high level of microsurgical expertise, but when performed by experienced surgeons, it delivers durable, natural-looking results. The SGAP flap is best for patients with adequate upper buttock volume who are willing to accept a more complex surgery.
How our surgeons help you choose the right option
At New York Group for Plastic Surgery, flap selection is a carefully considered process. Dr. Jordan Jacobs and the NYGPS reconstructive team take a methodical, patient-centered approach to breast reconstruction. Your consultation includes an in-depth assessment of your anatomy, vascular structure, prior surgeries, activity level, and aesthetic goals to help identify the most appropriate flap options.
Our plastic surgeons explain each option clearly, outline tradeoffs honestly, and recommend the technique that offers the safest surgery and the most natural long-term result for your body. If you’re ready to explore your options, schedule a consultation at NYGPS today.
