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In 1976 the first free flap for breast reconstruction was reported bij Fujino: he used the gluteus maximus myocutaneous flap. A skin-fat-muscle flap, including the superior gluteal artery and veins, was dissected and anastomosed to the thoracoacromial artery and vein [1]. In 1983 Shaw published a series of 10 patients undergoing the superior gluteal myocutanous free flap [2]: technical refinements were added to the work of Fujino. Only in 1993 Allen introduced the superior gluteal artery perforator (S-GAP) flap for breast reconstruction [3]. The pedicle of the flap was longer than that of the gluteus maximus myocutaneous flap because of the intra‐ muscular dissection: as a consequence a vein graft was not necessary to perform the micro‐ anastomosis: moreover no muscle was sacrified giving less donor site morbidity. In 2010 LoTempio and Allen published a review of the latest 17 years with gluteal flaps [4]: over the years the donor site is just improved, positioning the scar in the upper buttock superior from medial to lateral and beveling superior to reduce the contour deformity. Their experience showed a complication rate of 2 % of flap loss. The improvement in technique and results is also due to the introduction of new technologies such as MRA (magnetic resonance angiog‐ raphy) en CTA (computed tomography angiography) supporting the identification of the best perforator.

Septocutaneous Gluteal Artery Perforator (Sc-GAP) Flap for Breast Reconstruction: How We Do It