The skin and fat along the upper inner thigh is taken along with gracilis muscle and it’s blood supply to constitute the Transverse Upper Gracilis (TUG) Flap. This flap is widely used for breast reconstruction.Gracilis is one of the many muscles in the inner thigh which is responsible for bringing the thigh towards the centre. As many muscles in the thigh can do the same action, taking this muscle leaves no functional problems. The skin and fat look like a “ melon slice” which can be made into a cone shape to form a soft and shapely breast. The peak of the cone becomes the nipple. The blood vessel accompanying the flap is then connected to the blood vessel in the chest by advanced microsurgery to form a nice breast of a good shape.
The TUG flap from the inner thigh is shaped like a breast by folding it
Primary nipple reconstruction is done
For a patient who had breast cancer both sides, the breasts were removed both sides ,TUG flaps along with primary nipple reconstruction was done on both sides to make it look like breasts
The final result after TUG flap reconstruction for both sides of the breast
DIEP flap is usually considered as the gold standard method of breast reconstruction wherein we take the excess skin and fat from the abdomen to make a breast. This is because of the versatility of the flap and favourable donor site.TUG flaps are usedfor breast reconstruction for the following reasons
Breast reconstruction with the TUG flap is ideally done during the same sitting as the removal of the breast cancer. When the reconstruction is done together with the removal of the breast cancer, most of the skin can be preserved if it has not been involved with breast cancer and can give a good result for breasts with a small volume. It can also be done in a delayed sitting. However, as the skin is not preserved, we may have to use TUG flaps from both sides to give a breast of a good shape.
Before the operation, we evaluate the status of investigations and treatment of breast cancer. If the patient had not been evaluatedearlier, we do the necessary investigations for breast cancer. We would then assess the volume, ptosis, size of the breast and the donor sites for autologous reconstruction like the thigh, abdomen and back. We may take a CT Angiogram to know the position of the vessels. We would then discuss with the patient and her relatives about what needs to be done for breast cancer, how we can reconstruct the breast the best way and answer any doubts that the patient and her relatives may have.
The patient is evaluated in the microsurgical bay wherein the patient is near the operation theatre so that the doctors and specialised nurses can frequently visit the patient and look out for the viability of the flap and look out for haematoma. On the third day, we will mobilise the patient and try to make the patient sit down and slowly we will make the patient walk as soon as the patient is comfortable. We will also check the amount of fluid in the drains that are used to remove the excess fluid in the breast and the donor site in the thigh. When the amount of fluid in the drains reduce,we will remove the drains. Once all the drains are removed,and the patient can walk well, we will discharge the patient back home. The patient will need to stay in the hospital for a week. After discharge, we will see the patient once every week for two weeks. After the wounds heal,the patient is sent for chemotherapy if she needs it for her breast cancer treatment. Generally, the patient is sent for chemotherapy 3 to 6 weeks from the day of operation.
Fortunately, the complications of TUG flap are not very common. Any surgical procedure can have its complications. As it our duty to inform our patients of the complications that can arise we are enumerating the complications of the TUG flap namely