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Saint Louis Breast Reconstruction: TUG Flap

What is a TUG flap? A TUG flap, also known as the transverse upper gracilis flap, is a newer form of breast reconstruction that uses tissues from the inner thigh to reconstruct the breast. Skin and fat are taken from the inner thigh, leaving a well-concealed scar in the inner thigh similar to that seen with a cosmetic thigh lift. This skin and fat gets its blood flow from the underlying gracilis muscle. The skin, fat, and muscle are transferred from the inner thigh to the breast where the blood flow is re-established using microsurgery.

TUG-FLAP.

This means that the inner thigh tissues are transferred to the breast area and their blood vessels reconnected under a microscope to maintain blood flow. Surgeons, operating room teams, and hospitals that have significant experience with microsurgery perform the TUG flap. Candidacy for a TUG flap is determined by the specific anatomy of the inner thigh, previous thigh surgery, body weight and aesthetic expectations. The TUG flap does not provide as much volume for breast reconstruction as a free TRAM or DIEP flap. With a TUG flap, the reconstructed breast may be 50-90% as large as the original breast before mastectomy, but an implant and abdominal scar are avoided. The TUG flap may be safer for patients who are moderately obese (35-40) and can also be performed in patients of normal body weight.

TUG Flap Video

In appropriate cases, the TUG flap is an excellent option for breast reconstruction with the patient’s own tissues when she is not a candidate for or does not want a DIEP, SIEA, free TRAM or  latissimus flap

Reconstructive timeline with TUG flap:

  • First operation: Breast reconstruction with TUG flap(s) ± mastectomy
  • Office visits: Drain removals and wound checks.
  • 3 months*: “Touch up” cosmetic appearance of TUG flap if required; possible balancing procedure on other side. Possible fat grafts to optimize breast contours.
  • 6 months*: Nipple reconstruction. Possible fat grafts to optimize breast contours.
  • 8 months*: Areola (pigmented circular area that surrounds the nipple) reconstruction with tattoo.
  • 12 -24 months*: Laser or IPL scar therapy.

* If you are having an immediate TUG flap (mastectomy and TUG flap at the same time) and chemotherapy is required, please add 4 months to the timeline. If radiation therapy is also required, please add 9 months to the timeline.


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Anesthesia: A TUG flap is performed with the patient under general anesthesia.

Length of procedure: 4 to 5 hours for one breast, 6 to 8 hours for two breasts.

Estimated recovery time: Hospitalization is usually 4 to 7 days. You can return to work after 4 to 6 weeks depending on your job, and should avoid vigorous activities for 6 weeks. Visible bruising and swelling should begin to improve within 3 weeks. Recovery time, however, is highly variable and depends on your health before surgery and history of smoking and radiation therapy. Unless you have an allergy, you will be required to take aspirin for one year after surgery. To learn how to prepare for a TUG flap breast reconstruction and what to expect afterwards, click here to download our patient instructions.

Side effects: Common side effects include bruising and swelling. Blood flow to your flap will be carefully monitored after surgery. If there are concerns about the flap, you may require reoperation to assess the blood flow. You may have some early weakness in the thigh muscles, which should resolve. Some transient lower leg swelling and delayed wound healing in the inner thighs may occur.

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Meet Our Surgeons

There’s something different about West County Plastic Surgeons of Washington University. Not only do our surgeons provide an accessible and patient-friendly atmosphere, but we uphold Washington University’s reputation for cutting-edge procedures. We invite you to learn more about our surgeons.
Dr. Terry Myckatyn

Voted among the "Best Doctors in St. Louis" and "Best Doctors in America" by Best Doctors, Inc. since 2008, Dr. Terry Myckatyn is no stranger to being recognized for his work in plastic surgery. A board-certified plastic and reconstructive surgeon in the United States and Canada, Dr. Myckatyn specializes in all forms of cosmetic surgery and breast reconstruction. Read On

Dr. Marissa Tenenbaum

Dr. Tenenbaum – a board-certified plastic surgeon – specializes in all forms of cosmetic surgery and breast reconstruction, employing techniques acquired through working with some of the most respected cosmetic and reconstructive surgeons in the country. She has been voted among the "Best Plastic Surgeons" and "Best Doctors in America" by St. Louis Magazine. Read On

Emily Weinhaus P.A.

A licensed physician’s assistant, Emily performs non-invasive cosmetic procedures, such as BOTOX® injections, fillers, laser skin resurfacing, laser hair removal and spider vein treatments. Read On