The Gluteal Flap uses excess tissue of your buttock and is usually available even in very thin women. In general, however, the gluteal flap is a second choice to the TRAM flap and is usually reserved for women who are not implant or TRAM reconstruction candidates. The use of the gluteal flap avoids abdominal incisions and is therefore not associated with abdominal weakness or hernias.
The gluteal flap can only be performed using microvascular surgery and is technically more difficult than the TRAM Flap, and harder to shape into a breast.
It should also be noted that the gluteal flap is a technically more difficult operation than the TRAM Flap and is associated with a slightly higher (4 to 5%) failure rate. In addition, scar and depression in your buttock area may require liposuction or lifting of the other buttock to achieve symmetry.