title: Unilateral breast reconstruction using bilateral inferior gluteal artery perforator flaps.
abstract: BACKGROUND
  For reconstructing moderate-to-high projection breasts in nulliparous patients with insufficient abdominal tissue or prior abdominal surgeries, a unilateral inferior gluteal artery perforator (IGAP) flap is an alternative procedure. In patients with slim hips, however, unilateral gluteal tissue is insufficient and inferior gluteal crease displacement may develop postoperatively. Donor-site asymmetry is also a major disadvantage. In these circumstances, bilateral IGAP flaps provide sufficient tissue without significant gluteal deformity.
  
  
  METHODS
  We retrospectively reviewed 20 patients who underwent unilateral breast reconstruction using bilateral IGAP flaps by a single surgeon between November 2007 and December 2012. A quantitative outcome assessment was performed and compared with that of 22 unilateral IGAP flap patients operated on by the same surgeon.
  
  
  RESULTS
  Twenty patients underwent reconstruction with 40 IGAP flaps. Of the 40 flaps, 39 survived and 1 developed total necrosis due to repeated venous thrombosis. In 15 of 20 patients, the size of reconstructed breast was comparable to that of the contralateral breast. Final inset flap weight was 462.3 g for bilateral flaps and 244.3 g for unilateral flaps. Total operating time was 671.1 minutes (bilateral flaps) and 486.8 minutes (unilateral flaps).
  
  
  CONCLUSIONS
  Use of bilateral IGAP flaps for breast reconstruction helps to avoid asymmetry of the inferior buttock volume and shape. Bilateral flaps provide sufficient tissue volume and allow for reconstruction of a breast comparable to the unaffected side. In patients with moderate-to-high projection breast whose abdominal tissue cannot be used for reconstruction, IGAP flaps may be a suitable alternative.
authors: Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan; and the Department of Breast Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
authors: Toshihiko
authors: T
authors: Satake
authors: Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan; and the Department of Breast Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
authors: Mayu
authors: M
authors: Muto
authors: Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan; and the Department of Breast Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
authors: Marina
authors: M
authors: Ogawa
authors: Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan; and the Department of Breast Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
authors: Mai
authors: M
authors: Shibuya
authors: Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan; and the Department of Breast Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
authors: Kazunori
authors: K
authors: Yasumura
authors: Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan; and the Department of Breast Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
authors: Shinji
authors: S
authors: Kobayashi
authors: Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan; and the Department of Breast Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
authors: Takashi
authors: T
authors: Ishikawa
authors: Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan; and the Department of Breast Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
authors: Jiro
authors: J
authors: Maegawa