A transverse upper gracilis (TUG) flap is a newer form of breast reconstruction that uses skin, fat and a small strip of muscle from the inner thigh to rebuild the breast. The scar that results from this procedure is concealed in the groin.
The reconstructed breasts that result from a TUG flap are smaller than breasts reconstructed with either free TRAM flaps or DIEP flaps, usually 10 percent to 50 percent smaller than the original breast. The opposite breast can be reduced or reconstructed for a better match between sides.
TUG flap reconstruction is performed by surgeons, operating room teams and hospitals that have significant experience with a technique called microsurgery. Surgeons use microscopes and other special tools to connect blood vessels and maintain blood flow in the tranferred tissue.
Patients who are candidates for the TUG flap are typically healthy, have had no or minimal surgery on the thigh to be used for reconstruction and are of normal to moderately obese weight. Microvascular surgery alternatives include the free TRAM flap, DIEP flap or SIEA flap. Flap options that do not involve microsurgery, such as the latissimus flap or pedicled TRAM flap, also are alternatives.
TUG flap reconstruction is performed under general anesthesia and takes four to five hours for one breast and six to eight hours for both breasts. Patients are hospitalized for four to eight days and can return to work in four to six weeks.
Common side effects include bruising and swelling in the leg used to provide tissue. Several temporary drain tubes remain in place after surgery. Surgeons monitor blood flow carefully. Return trips to the operating room may be necessary to restore blood flow. Delayed wound healing occasionally occurs. Flap failure is uncommon.