Patient 3 Gallery

Before and after bilateral TUG flap breast reconstruction performed as a revision of prior breast reconstruction. This 46 year old woman had two previous breast cancers at age 27 and 29. She was initially treated with neoadjuvant chemotherapy and lumpectomies. Although she did not test positive for the BRCA gene, she chose to have bilateral mastectomies and was offered submuscular implant reconstruction and a latissimus dorsi (LD) flap to her left radiated side in her home town.

Her implants were painful and contracted, lying completely under her pectoralis major muscles and the latissimus muscle. The implants were too small for her breast footprint and did not match her former breast size. She was unhappy with her results and sought a softer, more natural reconstruction. She was a candidate for either a DIEP flap or a TUG (inner thigh) flap. She chose the TUG flap because she had more fat in this region and she was hoping to get back in shape and lose her belly fat on her own.

The previously placed implants were removed and her pectoralis muscles were returned to the chest wall. The pedicle to the previously rotated latissimus flap was divided and her breasts. Her breasts were reconstructed by microsurgically transplanting fat from her upper inner thigh regions, called the transverse upper gracilis (TUG) flap.

The skin from the inner thigh flaps was removed (de-epithelialized) and the tissue was buried beneath her native breast skin to avoid a “patchwork quilt” appearance of having a patch of flap skin showing. The volume of her reconstruction was double the volume of the too-small implants that were removed. Interestingly, the TUG flaps nearly perfectly matched the volume of her original breasts!

Follow up photos are shown at a year and a half after surgery. Her breasts have better symmetry and the past motion deformity from her muscles being pulled tight over the implants is gone. Her inner thigh scars are hidden in her groin crease in the front, and concealed in her buttock crease in the back.

While she hasn’t get lost the weight she was hoping to from her belly, free fat grafting is planned to fill in some mild contour depressions around her flap. This procedure uses liposuction to harvest as much fat as possible from sites such as her belly, the rest of her inner thighs, outer thighs, buttock rolls and axillary rolls (back fat/bra roll). Fat grafting with both improve the contour of the fat graft
donor sites as well as improve the aesthetics of her breast reconstruction in her second (and last) procedure.

She will undergo nipple and areola reconstructions at her second-stage surgery as well, which she is excited for! Her old tattoo will be ignored, as it is has an unnatural color and is in a poor position. The new nipples and areolas will overshadow the unusual shading of a past tattoo attempt. Stay tuned for her final results!