Traveling for Care?
Whether you're crossing the country or the globe, we make it easy to access world-class care at Johns Hopkins.
The transverse upper gracilis (TUG) flap uses tissue from the inner upper thigh near the natural groin crease, as well as the “gracilis” muscle, to create breast tissue. This is usually done if patients do not have adequate skin and tissue in the abdomen or buttock region, or have had previous abdominal surgeries that may have interfered with blood vessels that the DIEP flap requires. The ideal patient for the TUG flap is someone with small breasts who does not require a significant amount of volume for the reconstruction.
When the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about a silicone implant. The gracilis is a thigh “adductor” or helps to close the legs inward. However it is not a critical strength muscle and can be considered “expendable” since patients generally do not complain of weakness after surgery.
The biggest advantage is that the incision is fairly well hidden in the natural groin crease. This is easily hidden by standard clothing. The disadvantage of the TUG, which is why this is not a commonly performed operation, is that it provides only a modest amount of tissue for breast reconstruction. The TUG flap technique is suited for specialized patients; your surgeon will determine if you are a good candidate.
Your plastic surgeon will do everything possible to make your breasts look and feel natural. There will be scars at the tissue donor site as well as on the reconstructed breast, but these tend to be well hidden by standard clothing. Oftentimes patients require a final surgery after the TUG flap to make the breasts appear as symmetric and natural as possible. You should discuss with your surgeon all of your concerns and expectations for post-surgery appearance and recovery.
TUG flap surgery requires a hospital stay of three or four days. You will be able to begin eating on the first day after surgery, and you will get out of bed with assistance on the second day. You will be able to walk with minimal assistance on the day of discharge, and while at home you will be able to perform all necessary activities of daily living.
You will also have three to four surgical drains depending on whether one or two breasts are reconstructed. In most circumstances, these drains will remain in for one to two weeks. If they are highly productive they will stay in longer.
The recovery time for flap reconstruction is four to six weeks to resume most normal activities. You will be sore for about a week or two and then begin to improve every day.