Other Flap Procedures Buttock crease transfer surgery is a procedure that uses tissue (skin, fat, and muscle) from the buttocks to reconstruct the breast. It is similar to a free TRAM flap because the tissue is completely removed from its original site and transplanted to the chest. The blood vessels are cut and must be reattached to blood vessels in the chest area using very complex microsurgery techniques. The GAP flap is similar to buttock crease surgery. The tissue used to reconstruct the breast comes from the buttocks. But it consists of skin and fat only; no muscle is used. The tissue is completely removed from its original site, and microsurgery is used to reattach the blood vessels to vessels in the chest area. A breast reconstructed with tissue from the buttocks will feel natural to the touch, similar to one reconstructed with abdominal tissue. Recovery is usually a bit faster than recovery after a DIEP flap procedure. Breast Implants and Flap Procedures If you have a choice between an implant or a flap procedure, you’ll have many things to think about. For example, on one hand, flap procedures are more complex, somewhat more painful, and require longer recovery time than tissue expander/implant surgery. Further, they leave scars on the donor site (such as the abdomen or back) and on the breast. But, on the other hand, a breast reconstructed with a woman’s own tissue, especially from the abdomen, feels more natural than an implant, and avoids any possible complications from an implant (such as scar tissue hardening around the implant). Most scars do fade significantly over time (though they never completely disappear). And removing tissue from the abdomen (a “tummy tuck”) is often considered a “fringe benefit” of the surgery. Obviously, you should think about these issues, get information from other resources, and talk with your doctors. You’ll find the medical team at URMC to be especially empathetic, understanding, and helpful. They’re not only renowned experts in plastic surgery and breast reconstruction, they also understand the emotional difficulties you’re facing. As you work your way through the decisions, the surgery and the recuperation, you’ll be able to count on their compassion and concern, their time, their support, and their help.