Perforator flaps have allowed the transfer of a patient’s own skin and fat in a reliable manner with minimal donor site morbidity for more than a decade. They represent the latest in the evolution of soft tissue flaps and provide the reconstructive microsurgeon with more freedom to select a donor site that matches the skin color, thickness, texture, and subcutaneous fat quality of the recipient site. More attention can be paid to the aesthetic quality of the reconstruction. This article focuses on buttock flaps for breast reconstruction and covers aspects such as patient evaluation, selection, preparation, surgical technique, and complications of superior gluteal artery perforator and inferior gluteal artery perforator flaps.