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Division of Plastic Surgery, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec Correspondence: Dr Louise Caouette Laberge, Centre Hospitalier Universitaire Sainte-Justine, 3175 Côte-Sainte-Catherine, Room 7907, Montreal, Quebec H3T 1C5. Telephone 514-345-4771, fax 514-345-4964, e-mail l.caouette-laberge@umontreal.ca Correction of severe breast asymmetry in teenage girls presents many challenges. The reconstructed breast should provide symmetry in size, texture and shape that can change naturally with body weight variations and aging. To meet these goals, autologous reconstruction is an excellent option in patients with severe asymmetry. Given that the body constitution of teenagers is often not abundant in adipose tissue, the buttock area becomes an interesting possibility because of its consistent availability of fatty tissue. Since 1996, our team has used the buttock area as the donor site for breast reconstruction in teenagers: the inferior gluteal musculocutaneous flap until 2005 and, since then, the inferior gluteal artery perforator (IGAP) flap. The donor-site morbidity of the musculocutaneous flap was reviewed by our team in 2007 (1): the principal morbidities were posterior thigh hypoesthesia and lateral thigh depression. Some studies on the IGAP flap have included a donor-site morbidity outcome, but it has always been qualitative or subjective in nature (2-12). The expectation of a ‘perfect’ result in this teenage population is common; therefore, it is very important that patients have a clear understanding of the surgery’s limitations, particularly regarding donor-site morbidity. The aim of our study was to objectively assess the impact on donor-site morbidity of preserving the gluteus maximus muscle and of minimizing the area of dissection with the use of the perforator variant of tissue harvesting, the IGAP flap. METHODS The present study was approved by the Scientific and Ethics Committee of the Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec. The methodology used in the present study was the same as that described in the authors’ previous report on the donor-site morbidity of the inferior gluteal musculocutaneous flap (1). All cases of breast reconstruction using an IGAP flap in teenagers performed between 2006 and 2011 were included. The patients’ charts were reviewed for demographic data, comorbidities, smoking and flap weight, as well as perioperative and postoperative courses. Photographic assessment (with consent) during the patients’ follow-up visits was used for aesthetic evaluation of the buttock shape and projection, thigh deformity and scar quality. The second part of the present study consisted of a physical evaluation and a questionnaire. The aesthetic aspect of the donor site addressed the scar and the buttock contour. The scar was examined for pigmentation, texture and dimension. The buttock was evaluated for possible flattening, lateral thigh depression and position of the gluteal crease. Sensory assessment was performed first by running a finger along the posterior thigh to delineate a possible zone of dysesthesia (defined as an unpleasant, abnormal sensation). Subsequently, the smallest Semmes-Weinstein monofilament felt on the skin of the normal buttock and thigh was used to better define the borders of that original article