Dr. Craig has obtained years of training at MD Anderson Cancer Center in Houston and in her plastic residency at Yale School of Medicine. She has trained with leading breast reconstructive surgeons Dr. Roger Khouri and Dr. Phillip Blondeel. Their practice integrates the latest advancements in SIEA, SGAP, and PAP flap surgery for improved patient safety and aesthetic results.

SIEA, SGAP, and PAP Flaps: Different Types of Free Flap Surgery

With any breast reconstruction procedure, the goal is to restore the natural look of your breasts’ size and shape by choosing a procedure that works with your body and cancer treatment plan. SIEA, SGAP, and PAP flap surgeries are all types of free flap surgery that transfer tissue, skin, and blood vessels from a donor site to your breast to restore the shape and volume after a mastectomy. The advantage of these perforator free flaps is that they use microsurgical techniques to minimize any damage to the surrounding tissue where the tissue is harvested from.


Known as a superficial inferior epigastric artery (SIEA) flap and SIEP flap, this procedure removes a section of blood vessels, fat, and skin from your lower abdomen. SIEA flap surgery is best for Houston patients with extra fat and tissue just below their belly button.


The donor site for the superior gluteal artery perforator (SGAP) flap is your upper buttocks. The fat, blood vessels, and skin are transferred to shape your new breast mound. This procedure is recommended for patients who have excess fat and tissue in their buttock region.

PAP Flap

The profunda artery perforator (PAP) flap transfers blood vessels, fat, and skin from your upper inner thigh to restore your breast mound. This area sits right below your buttocks and is often recommended for Houston patients with small or medium breasts.

Possible Complications

Although rare, there are some complications associated with SGAP, SIEA, and PAP flap surgeries. The risks are:

  • Flap Thrombosis that compromises the vascularity to the transferred tissue and can result in the need to revise or, in some cases, return to the operating room to re-establish blood flow.
  • Infection that makes surgical areas warm, red, and may result in flu-like symptoms. Antibiotics are prescribed, and infection often combatted if caught early.
  • Delayed healing due to poor vascularity to the involved area or pressure on the healing skin.
  • Scar tissue that can cause you pain or create an uneven texture at the surgical site. Many women seek additional alternative therapy to avoid scarring, but your choice of plastic surgeon and procedure can help minimize scarring.

All risks of complications are greatly reduced when you choose a qualified breast reconstruction surgeon to perform your procedure.

How Do I Choose the Flap Surgery That Is Right for Me?

Several different techniques for flap surgery were developed to accommodate different body types. All of these procedures involve removing fat, blood vessels, and skin from a donor site on your body and grafting the tissue onto your breast. Dr. Fusi and Dr. Craig will evaluate which area of your body has the best donor tissue by determining:

  • The amount of tissue required to create your new breast size.
  • Which donor site has the shape and texture needed for breasts that look and feel natural.
  • Your preferences for a specific procedure based on aesthetic results such as scarring and incorporating body contouring into the donor site surgery.

Factors such as your health, medical history, and cancer treatment plan will also be taken into account to ensure that your reconstruction is performed when you are in the best possible health for surgery and recovery.

How Do I Find a Qualified SIEA, SGAP, and PAP Flap Surgeon in Houston?

Many patients in Houston are familiar with the cancer center that is located in their city. Your breast reconstructive surgeon should also have:

  • Extensive microsurgical training needed for SIEA, SGAP, and PAP flap surgery.
  • Training in free flap breast reconstructive surgery from renowned experts.

Dr. Craig is a board-certified reconstructive surgeon with experience in the latest microsurgical techniques from her training at MD Anderson Cancer Center in Houston. She can perform the delicate blood vessel connections needed for free flap surgery and has advanced aesthetic training to restore the natural look of your breasts.

Dr. Craig has received one-on-one training from top breast reconstruction surgeons Dr. Roger Khouri and Dr. Phillip Blondeel, and joined the successful practice of Dr. Fusi, top surgeon of the region who is now retired, where they both combined their training and expertise for patients throughout Houston.

For more information on SIEA, SGAP, and PAP flap surgery, contact our Houston office at 713-346-9909.