Reconstructive surgery using your inner thigh

TMG (Transverse Myocutaneous Gracilis), TUG (Transverse Upper Gracilis), DUG (Diagonal Upper Gracilis) and LUG (L-shaped Upper Gracilis) Flaps

The TUG, TMG, DUG or LUG flap procedure uses your own tissue (autologous) and some muscle from the inner thigh area. Some women may be too slim for an abdominal flap, or may have had previous surgery to the abdomen that may prevent a reconstruction from being taken from the abdomen. In a TUG, TMG, DUG or LUG flap procedure the skin, fat, blood vessels (perforator) and thigh muscle is completely freed from its original location and reattached to blood vessels in the chest/axilla using microsurgery. This procedure results in a tightening of the inner thigh area with a scar (scars may be seen when wearing knickers or swimwear).

This procedure may involve removing a small piece of the 3rd or 4th rib or cartilage to enable access to the blood vessels on top of the lungs. Sometimes the surgeon can find these vessels in between the ribs. Alternatively, the flap can be connected to blood vessels in the axilla (armpit). This depends on your unit/surgeons preference. The surgeon will use a microscope to reconnect the blood supply.

Bipedicled, Bilateral or Stacked TUG/TMG/DUG Flaps

As with using both sides of the abdomen (bipedicled or stacked DIEP) to reconstruct a breast, it is also possible to use both thighs to reconstruct one breast. This technique is used if there is not enough skin, fat and muscle in one thigh. A recent innovative approach is to use the skin, fat, muscle and blood vessels from both thighs. Effectively this is two TUG/TMG/DUG/LUG flaps (one from each thigh) which are joined together and then transferred up to the chest to be reconnected to reconstruct a breast.

PAP (Profunda Artery Perforator) Flaps

The PAP flap is similar to a TUG/TMG/DUG/LUG flap however; it does not involve transferring any muscle. This flap relies on a blood vessel that runs through your thigh at the back just below your buttocks. It involves harvesting fat and skin from the back of the upper thigh with the blood supply, the block of tissue is completely freed from its original location and attached to blood vessels in the chest area using microsurgery to use to reconstruct a breast.

Come to a Show & Tell event

Find out more about different types of procedure and the experiences of patients by coming along to one of our events.