(1) Background: The superior gluteal artery perforator (SGAP) flap is a prominent technique for autologous breast reconstruction. Unlike other commonly used techniques, current literature on the safety and efficacy of the SGAP flap is heterogenous and limited. The aim of this article was to perform a systematic literature review and meta-analysis of postoperative outcomes and complications associated with SGAP flap autologous breast reconstructions.

(2) Methods: A systematic literature search of multiple databases was performed using the PRISMA guidelines. We included articles evaluating SGAP flaps in autologous breast reconstruction. Outcomes and complications were recorded and analyzed. Proportions and their 95% confidence intervals (CIs) were calculated in a random-effects meta-analysis.

(3) Results: Fourteen studies meeting inclusion criteria, representing a total of 667 SGAP flaps, were included. The total flap loss rate was 1% (95% CI 0-3%), partial flap loss rate was 1% (95% CI 0-3%), hematoma rate was 3% (95% CI 1-6%), emergent surgical re-exploration rate was 5% (95% CI 2-9%), and overall donor-site complications were 12% (95% CI 4-23%). (4) Conclusions: This systematic review and meta-analysis provide comprehensive knowledge on the efficacy and safety of the SGAP flap in autologous breast reconstruction. It demonstrates its overall safety and low complication rate, validating its important role as an effective option in breast reconstruction.