Superior Gluteal and Lumbar Artery Perforator Flaps in Autologous Breast Reconstruction: A Systematic Review and...

Autologous breast reconstruction provides superior long-term outcomes compared with implant-based techniques, particularly, in patients requiring radiotherapy. Although abdominal-based flaps remain the gold standard, many patients are unsuitable candidates, necessitating alternative donor sites. The superior gluteal artery perforator (SGAP) and lumbar artery perforator (LAP) flaps are established nonabdominal options; however, comparative outcome data remain limited.

A systematic review and meta-analysis were performed according to PRISMA guidelines. Major electronic databases were searched for studies published up to January 2026 reporting outcomes of SGAP and/or LAP flaps in oncologic breast reconstruction. Random-effects meta-analyses of proportions were used to calculate pooled estimates for total flap loss, overall complications, donor-site seroma, and vessel graft utilization.

Twenty-three studies met inclusion criteria, including 14 SGAP and 9 LAP series, comprising 475 SGAP and 440 LAP patients. Pooled total flap loss rates were 3.9% (95% CI, 2.1%-6.1%) for SGAP flaps and 9.7% (95% CI, 6.6%-13.2%) for LAP flaps (p = 0.0016). Overall complication rates were lower for SGAP flaps (35.5%; 95% CI, 24.0%-47.9%) than for LAP flaps (55.2%; 95% CI, 44.7%-65.4%) (p < 0.001). Donor-site seroma occurred in 26.5% of SGAP and 33.3% of LAP reconstructions (p = 0.003). Vessel graft utilization was uncommon in SGAP reconstruction (1.5%) but routine in LAP reconstruction (97.9%) (p < 0.001).

Both SGAP and LAP flaps are reliable nonabdominal options for autologous breast reconstruction. However, differences in flap loss, complication profiles, donor-site morbidity, and technical demands highlight the need for individualized flap selection based on patient anatomy and microsurgical expertise.

PROSPERO number: 559731.