Introduction: Free flap failure after breast reconstruction can pose technical dilemmas for secondary reconstruction regarding recipient vessels and tissue availability. When the abdominal tissue is unavailable for harvest, the gluteal artery perforator flap (GAP) may be used for breast reconstruction. Often, the internal mammaries are unavailable, and the thoracodorsal vessels must be used as the recipient vessels. The inferior gluteal artery perforator flap (IGAP) provides sufficient pedicle length in this situation.

Purpose: We will illustrate the usefulness of the IGAP and superior gluteal artery perforator (SGAP) flap after failed free flap breast reconstruction. The decision to use either flap may be influenced by recipient vessel availability, and donor site contour.

Material/Methods: Three patients with complete flap loss after DIEP/TRAM breast reconstruction were reviewed after secondary breast reconstruction. Two patients underwent an IGAP flap using the thoracodorsal vessels as the recipient vessels. One patient underwent a SGAP using the internal mammary vessels.

Results: There was no flap loss or fat necrosis in these patients after secondary breast reconstruction. One patient, after IGAP reconstruction, required revision of the venous anastomosis. Another patient, after SGAP reconstruction, developed a donor site wound infection. Final flap weights were comparable to previous flap weight.

Conclusion: Use of the IGAP or SGAP flap after failed free flap breast reconstruction may be individualized based on donor site contour and recipient vessel availability.