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TUG Flap,

Inner Thigh Flap Breast Reconstruction

For patients who benefit from reconstruction using their own body tissue, the abdominal skin and fat remains the most commonly utilized tissue to create a breast mound (DIEP flap or TRAM flap). However, if that option is unfavorable due to a slender body type, or not available due to previous abdominal surgery, a more recent option is the transverse upper gracilis free flap (TUG flap) or inner thigh flap.

The TUG flap utilizes fatty tissue of the inner thigh to reconstruct the breast. The gracilis muscle and its blood vessels carry the blood supply and allow the free transfer to the chest. The gracilis muscle is a small adductor muscle that is expendable without any noticeable loss of strength, as multiple other adductor muscles compensate for its function. The skin and fat carried by the inner thigh flap can be a transversely oriented ellipse just below the groin and buttock crease, which allows the donor site to be closed similar to a thigh lift, resulting in a well concealed scar. Alternatively the incision can be extended vertically along the inner thigh to capture more tissue volume (fleur-de-lis design). This allows larger breasts to be reconstructed with the inner thigh flap.

TUG flap breast reconstruction

Tug flap breast reconstruction

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TUG flap Fleur-de-lis design

Tug flap vertical incision

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The TUG flap can be harvested from one side or both inner thighs for unilateral or bilateral breast reconstruction, respectively. Flap elevation can be completed at the time of the mastectomy; the TUG flap is then transferred to the chest and its blood vessels are connected using the operating microscope. Advantages to the inner thigh flap reconstruction include the softness and pliability of the tissue from the inner thigh providing for superior shaping of a natural appearing reconstructed breast with excellent projection. The scar along the inner upper thigh is well hidden and the leaner contour of the inner thigh similar to the contour after a thigh lift procedure may be a desirable additional benefit. Furthermore, compared to reconstruction using tissue from the buttocks (GAP flap) the operative set up is more efficient, allowing for a reliable flap elevation. However, depending on the individual patient’s body type, the volume of tissue that can be transferred from the inner thigh may be less compared to an abdominal or buttock flap, making appropriate patient selection for the TUG flap important.

You are an ideal candidate for TUG flap reconstruction if you:

  • have an athletic body with small amount of abdominal fat,
  • have had certain abdominal surgery (e.g., tummy tuck, ventral hernia repair), that preclude the use of abdominal flaps,
  • have some excess fatty tissue along the upper inner thigh (thighs touching each other),
  • require medium or small volume for breast reconstruction,
  • favor a more naturally shaped and softer feeling reconstructed breast over implant reconstruction.

You are not an ideal candidate for TUG flap reconstruction if you:

  • have excess abdominal tissue favoring a DIEP flap harvest,
  • have tight and skinny thighs,
  • require large volume for an adequate size breast reconstruction,
  • do not wish to have a thigh-lift scar.

During the postoperative care after the inner thigh flap you will be provided with a compression garment for the thighs. Minor wound healing problems at the inner thigh are not uncommon and may require dressing changes; the final scar, however, remains very favorable. While sitting in a chair for any extended time should be avoided during the first two weeks after surgery, laying in bed, sitting in a reclining chair, and walking will not interfere with the wound healing and is encouraged. For additional instructions please refer to the post-operative abdominal flap section.

Please go to our Personal Stories section to see before and after photos.