TUG Flap (using thigh tissue)

Tug Flap Reconstruction – (Transverse Upper Gracilis flap)

The tissue and skin is taken from the upper inner thigh area and is used to reconstruct the breast. Part or all of the gracilis muscle is taken along with the tissue from the inner thigh to ensure a reliable blood supply and is connected via blood vessels using microsurgery. The tissue and muscle from the inner thigh in a ‘melon like’ slice makes a cone shape to form a soft and shapely breast. The peak of the cone becomes the nipple. This is a very good option if tissue from the abdominal area is not available either because the patient is very slim or possibly because of too much scarring from previous operations such as appendicitis, caesarian section or abdominoplasty.

Several days before the operation the patient will have an anaesthetic assessment to establish that they are fit for the lengthy procedure. This will take into account the patients medical history and their general health.

A CT scan is always carried out prior to surgery. This is used to visualise and assess the flow patterns of arteries and veins and provides information about the best place to the take the tissue from before the operation begins.

Pros

This type of procedure can be used for delayed or immediate reconstruction successfully.
A TUG flap reconstruction gives good projection and volume for the new breast as it contains muscle from the inner thigh.
The effect of the gracilis muscle being taken from the inner thigh is unlikely to be noticed by the patient.
The reconstructed breast will change with the opposite breast – it will alter as you alter in shape and size as it is living tissue.
This form of reconstruction usually improves over time.
This is an option for those women who are unable to use tissue from the abdomen either because they do not have enough fat or they have previous scarring.
One operation, generally with no further maintenance.
Nipple reconstruction is done at the time of reconstruction.

Cons

It is a major operation, usually 4-5 hours of surgery and a 7 night hospital stay.
The flap is monitored every hour for the first three days in a High Dependency Unit (HDU). There is a small risk of failure of the flap at this stage and this could result in emergency surgery.
Generally more suitable for a smaller breasted patients.
Sitting down can be uncomfortable for up to a month.
The failure rate is increased by factors such as obesity, smoking, diabetes, radiotherapy and other medical conditions.
Risks associated with all surgery

Video

To look at more videos click here

Facts at a glance

Surgery time	4 Hours
Hospital stay	6-7 Days
Anaesthetic assessment	Yes
Bladder Catheter	Yes
Confined to bed	2 Days
Up and walking	3rd day
Reasonably mobile	5th day
Full recovery	6 – 8 weeks
Time off work	4 weeks
Bras and garments	Yes
Possible reconstruction issues	Tenderness on sitting down
Long term issues	Subtle change in thigh contour, usually tighter inner thigh
Secondary surgery	Rarely