The superior gluteal artery perforator (SGAP) flap procedure uses tissue from the top of your buttocks to recreate the breast mound. This is usually done if your surgeon cannot use the tissue in your abdomen, because you don't have enough fat or you have scarring from past surgeries.
This type of reconstruction will not be possible for every patient and depends on the amount of extra tissue available in your buttock area. However, the new breast will be softer and have a more natural shape than an implant.
Taking tissue from the buttock leaves a dent in that area that you can notice when you wear clothes. It also leaves a scar.
You will have an appointment at the Pre-Admission Clinic
within 2 weeks before your surgery. This visit is very important to assess your health and help you prepare for your operation and recovery. Depending on your needs, this visit may take from 2 to 5 hours.
On the day of your Pre-Admission visit, take your medications and eat as usual, unless you were given other instructions.
Pre-Admission Clinic
Toronto General Hospital
Eaton Building – Ground Floor, Room 400
TGH Maps & Directions
- Your health card (OHIP). If you do not have an OHIP card, please bring another form of government-issued photo ID, such as a driver's license or passport.
- Any other insurance cards. You will need the policy number of your extended health insurance, if you have any.
- Your spouse/partner, a trusted friend or family member (to offer you support and be a second set of ears).
- All the medications you take in their original containers. This included prescription medications, over-the-counter medicines, vitamins, supplements and herbal or natural products.
- A copy of your power of attorney for personal care and/or advanced directives.
- A list of any questions you may have about the operation and recovery.
- The name or phone number of your pharmacy, as well as any medical specialists that you have seen in the past 3 years. If you have had a cardiac stress test, echocardiogram and/or a pulmonary function test in the past 3 years, it would be helpful to bring a copy of the final report with you to this appointment.
- You will have blood tests and routine skin swabs. The swabs are taken from your nose and other areas of your body to check for germs that can cause infections.
- You may also need an ECG to check your heart and chest x-ray to check your lungs.
- You will meet many health care providers during your pre-admission visit. Please feel free to ask them any questions that you may have:
- A
pre-admission nurse will review your health history and give you information to prepare you for your operation, including directions for cleaning your skin, eating before operation, taking your medications, and pain management.
- A
pharmacist will review your medications.
- Depending on your needs, you may also meet:
- An
anesthetist who will review your health history, discuss your anesthetic plan and pain relief after operation.
- A
member of the medicine team, if you have other complex health problems.
- A
Clinical Nurse Specialist (CNS), or Nursing Coordinator, who specializes in the care of patients having your specific operation. They will review any preparation that is required before your operation, plans for discharge home after operation and specific instructions regarding your recovery.
Stop eating food by midnight on the night before your operation. Your stomach needs to be empty.
-
STOP eating food at midnight on the night before your operation.
- You may drink clear fluids up to 5 hours before your operation.
- Examples of clear fluids you can drink:
- Apple juice
- Beef or chicken broth (no noodles or vegetables)
- Orange juice (without pulp)
- Grape juice
- Jell-O or popsicles
- Cranberry juice
- Pop (such as ginger ale, 7-Up, Coke)
- Lemonade
- Water
- Coffee or Tea (no milk)
Arrive
2 hours before your scheduled operation time:
Surgical Admission Unit (SAU)
Toronto General Hospital
Peter Munk Building – 2nd Floor
TGH Maps & Directions
All hospital entrances are open by 6:00 am. However, Elizabeth St. and University Ave. are easiest to access.
- We will prepare you for the operation.
- If you did not see the anesthetist in the Pre-Admission Clinic, you will meet them before your operation.
- We will mark the area where we are doing your operation.
- We will give you a small needle with Heparin, a medication to help lower the chance of developing blood clots.
- We will give you an intravenous (IV) drip. This is a small needle that we put in a vein in your arm. We use it to give you one or all of the following: fluids, antibiotics and pain medications.
On this page, you can read all about what to expect during your hospital stay. Or, just click on one of the links below, to get the answer you want right now.
- You will wake up in the
Post Anesthetic Care Unit (PACU) and stay there for 1 – 2 hours.
- Once you are ready to leave the PACU, you will be moved to the
Breast Restoration and Plastic Surgery Inpatient Unit. For the first 18 to 24 hours, you will be in the Step-Down Unit for close observation.
- You will be attached to some or all of these tubes:
IV – We usually take the IV out as soon as you can drink fluids and pass gas.
Oxygen – Oxygen helps you breathe. We use either nasal prongs or a clear plastic mask.
Catheter – We will insert a Foley catheter into your bladder in the operating room once you are asleep. This will help drain your urine to prevent your bladder getting distended. This will be removed the next day (within 24 hours).
Patient Controlled Analgesic (PCA) – This is a pain pump that is attached to the IV initially after operation. You will have a button, where you can press to self-administer pain medication. - The nurses will give you a medication through the IV (antibiotics, anti-nausea).
- Once you are eating and drinking, we will prescribe pain pills that can be taken as needed and the PCA will be disconnected.
- Initially after your operation you may feel drowsy and tired.
- You may experience some pain at your surgical sites and/or nausea. We will manage your symptoms with medications.
- You may feel some tightness in your buttocks.
- After a breast reconstruction operation, it is normal to feel stiff in your back, chest, shoulders and arms.
- It is important to do range of motion exercises post-operatively to encourage circulation.
- The following day after your operation you will be up to chair and moving slowly.
- At the end of your hospital stay you will be able to do light activities of daily living (e.g., walking, toileting, getting dressed, personal hygiene).
- You can expect to be in the hospital for 3 to 4 days. Your health care team will talk to you about your stay once you're out of the PACU.
Please monitor the surgical sites for signs of infection (increasing redness, pain, fever). If you are concerned about the surgical site, please contact your surgeon's office or return to the emergency department at the hospital where your operation was performed.
It takes time to heal and recover. Each person recovers at their own pace. How long it takes for you to recover depends on your age, health and attitude. Your family doctor can help you to manage any symptoms you may have.
- There are no dietary restrictions; you may eat what you can tolerate.
- Some people experience some fatigue and may feel they get tired easily.
- Take frequent rests in between your activities.
- Your body will guide you of how much activity you can tolerate.
- Avoid strenuous activities and gluteal/buttock exercises.
- Avoid heavy lifting; do not lift anything more than 10 lbs for 8 to 12 weeks.
- Do not push heavy objects.
- You will be given a prescription upon discharge from hospital; please take your medications as directed.
-
DO NOT drive when you are still taking pain medications.
- You may start driving once you are able to check your blind spot safely and you must feel comfortable to make a sudden jerky movement in case of an emergency.
Go to your nearest emergency department if you see these signs of infection:
- Your temperature goes higher than 38°C (100°F) and lasts longer than 24 hours.
- If you feel chills.
- Bright red, hot and swollen incisions and skin.
- White fluid or pus or pus that smells bad.
The Nurse Coordinator is your first place to call for post-operative questions:
Agnes Wisniewski RN, BScN, MN
Phone: 416 340 4800 ext. 5161
You can also call your surgeon's office for more information.
Before you leave the hospital you will be reminded to call your surgeon's office to schedule a follow-up appointment:
When
About 3 weeks after the surgery.
Where
There are two clinics associated with the Breast Reconstruction Program.
Princess Margaret Cancer Centre |
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2nd Floor, M. Lau Breast Centre.
Toronto General Hospital |
Maps & Directions
7th Floor, Plastics Clinic
What to Expect
Your surgeon will assess your surgical sites for their healing progress and speak to you about your recovery. Your surgeon will let you know when you should return for a second follow-up during this appointment. You will be required to call the office to schedule this.
What to Bring
You will need to bring your health card to your appointment.
