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TUG Flap

This technique of breast reconstruction after mastectomy (breast removal for cancer) involves the use of tissues from the upper inner thigh of the patient the tissues include skin fat and a portion of muscle (gracilis). Transverse Upper Gracilis (TUG) Flap is a widely used microsurgical method for post mastectomy breast reconstruction.


TUG flaps are indicated in young patients with small to medium sized breasts, those who do not require a large amount of tissue for reconstruction and those whose inner thighs touch. It is ideal for young patients who have not been through a pregnancy and thus do not have sufficient extra skin and fat in the abdomen for reconstruction, or in those who have undergone previous abdominal surgeries. TUG flap is the best choice for women who are planning to get pregnant, those who smoke, or who have diabetes and circulatory diseases.


During breast reconstruction using TUG flap, your surgeon will make a crescentic ( half-moon shaped) incision on your upper thigh and will remove the gracilis muscle along with blood vessels, fat and surrounding skin. This is then transferred to the chest region where it is formed into a breast. The blood vessels are matched to those in the region of the chest where they are reattached.

  • Recovery: After a hospital stay of 3-4 days, you will be able to walk with minimal assistance. Your operated thigh would initially feel tight with a little discomfort. Pain and discomfort fades away as healing progresses and you will be able to resume your normal activities within 4-6 weeks.
  • Appearance: Your plastic surgeon takes all the necessary measures to meet your post-surgery expectations of symmetrical breasts that look and feel natural.
  • The donor scar (in the upper thigh is extremely well hidden, and easily covered by your under-garments.

Risks and complications
As with all surgical procedures, TUG flap reconstruction is associated with certain risks and complications. Some of them include:
  • Formation of lumps or scar tissue
  • Infection
  • Delayed wound healing
  • Tenderness or sensitivity to touch
  • Tissue breakdown: death of transplanted tissue due to insufficient blood supply

The advantages of TUG flap include:
  • Scars are concealed and not evident
  • Negligible death of donor site (from where tissue is taken for reconstruction)

The disadvantages of TUG flap include:
  • Lymph fluid leakage and retention (lymphedema). With the newer refined technique, where the major veins and all the lymphatic tissue in the leg are preserved, this complication is rare.
  • Wound dehiscence (rupture of wound along surgical sutures)
  • Inadequate tissue to reconstruct large-sized breast

Your doctor will weigh the advantages and disadvantages and suggest the best surgical intervention for breast reconstruction.