Superior gluteal free flap breast reconstruction.

The authors substantial experience with the superior gluteal free flap for breast reconstruction indicates that this is a more difficult but important free flap for breast reconstruction. Compared with the standard transverse rectus abdominis myocutaneous (TRAM) free flap, it is a much less forgiving operation with many specific technical details. With careful attention to details on flap design, recipient vessel selection anastomsis, and flap insetting, the success rate and morbidity of the gluteal flap operation are highly acceptable. For patients unsuitable for the TRAM flap for autologous tissue reconstruction, this is a very valuable alternative. It can achieve some spectacular results in breast reconstruction in terms of volume, replacement, and projection--even in very thin patients.