Other tissue reconstruction options are available to patients that have had previous abdominoplasty (tummy tuck surgery) or surgical procedures that preclude the use of abdominal tissue for breast reconstruction.  In addition, very thin or athletic patients may not have enough abdominal subcutaneous fat to be a candidate for SIEA or DIEP breast reconstruction.  In many of these patients, the TUG flap can be used to reconstruct small and medium breasts.  Skin from the inner thigh along with the underlying gracilis muscle is used to provide a well vascularized and shapely reconstruction.  Unlike loss of the the rectus muscle, loss of the gracilis muscle does not result in any significant increase in hernias or functional loss in the legs. Although the TUG flap is not performed widely in the United States, we believe this reconstruction is an excellent choice for many patients and provides some of the best aesthetic results we have seen. The unique shape of the tissue removed from the inner thigh allows shaping of a breast with an almost ideal contour and projection. And, this flap uniquely provides the potential for immediate nipple areola reconstruction, without tattooing.

We have been proponents of the TUG flap because of the many advantages it has.

They include:

1. Superior breast shaping
2. Immediate nipple areolar reconstruction in some patients
3. Consistent and excellent blood supply
4. Inner thigh lift
5. A high success rate with skilled microsurgeon
6. Can be used in immediate or delayed reconstruction

The tissue from the inner thigh is removed with some underlying skin, fat and expendable gracilis muscle. The flap is then sculpted to a circular shape with some conical projection.  This is outlined in figures A, B and C below.  The flap as it is shaped in C can be placed in the breast pocket of the mastectomy, and circulation is reestablished microsurgically to the internal mammary blood vessels. Just like in the DIEP and SIEA procedures further shaping is done to match the opposite breast as closely as possible. Superior results can be obtained with immediate reconstruction and skin sparing mastectomy

The TUG flap breast reconstruction uses inner thigh tissue

SCULPTING THE TUG FLAP

The crescent shape of the TUG flap allows it to be shaped by coning, giving it projection, and a rounder appearance. The projection is superior to that created by DIEP and SIEA flaps, and gives a more natural contour to the new breast. By using the crescent shape and folding to full advantage, the nipple areola structure can be created. The natural darker color of the inner thigh compared to the relatively pale breast color, give the areola superior shading of skin than can be obtained with tattooing.

The flap is sculpted into the shape of a breast

The TUG flap donor area on the inner thigh

The inner thigh lift is performed during the reconstruction, with the thigh wound closed under some tension. The patient is asked not to abduct (spread apart) their legs for several days.  Over the course of the in hospital stay, the tension on the incision site begins to soften and the patient resumes a recovery similar to the DIEP or SIEA flap patient.