Transverse Upper Gracilis Flap Breast Reconstruction St. Louis

During a TUG flap procedure, a woman’s inner thigh tissue is used to reconstruct the breast. No implants are used as part of the reconstruction. Generally, skin, fat and muscle from the inner upper thigh is used. One or both thighs may be used for a unilateral or bilateral mastectomy.

Candidates

Candidates for this procedure include patients who are having or have had a mastectomy or are unhappy with a previous expander/implant reconstruction. Patients with previous radiation are also excellent candidates for this procedure. Women who do not desire abdominal flap reconstruction or are unable to have reconstruction with their own abdominal tissue as a result of prior abdominal surgery or inadequate volume of tissue are also candidates.

Poor candidates for this surgery are women who have little fat on their thighs and, therefore, may not be able to attain the breast size they desire.

Preparing for Surgery

Dr. Cabbabe will ask that you refrain from taking any aspirin, plavix, Coumadin, ibuprofen or any other type of blood thinner. If you are taking chemotherapy, this will need to be finished prior to surgery.

Surgery

During the procedure, the breast surgeon performs the mastectomy first. If a mastectomy has already been done, then Dr. Cabbabe begins with the patient lying on their back. Tissue including skin, fat and muscle is removed from the upper inner thigh along with an artery and vein attached. The site where the tissue was removed is closed with sutures and a drain is placed.

Blood vessels between the ribs are identified to provide inflow of blood into and out of the skin, fat and muscle from the thigh. Under a microscope, the artery and vein (s) are reconnected with fine sutures to re-establish blood flow to the flap. The breast is then shaped and molded on the chest to recreate the breast.

A breast lift or breast reduction may be needed on the other breast in order to improve symmetry if a unilateral mastectomy is being done.. A new nipple can be made and areolar tattooing can be done if desired in the case of mastectomy.

Recovery

You will be admitted to the hospital for two to four nights. Pain medication and antibiotics will be prescribed. Dr. Cabbabe and the nursing staff will continually monitor the tissue flap. You will take aspirin daily for up to 6 weeks and be asked to avoid caffeinated beverages for a couple of weeks. There may be some numbness on the breast and thigh which improve with time. Most patients are able to shower within 24 hours. Drains will be placed inside the breast and in the thigh. Recovery is approximately 3 to 6 weeks.

Types of Reconstruction: