Before and after bilateral delayed breast reconstruction with the TUG flap and a later sub-flap implant in a 53-year-old breast cancer survivor. This patient previously had implants for reconstruction with severe, painful Grade IV capsular contracture. She elected to have her implants removed first, to give her body a break, before proceeding with a successful microvascular free flap reconstruction.
She had already had an attempted DIEP flap reconstruction at another hospital which was abandoned after 16 hours of surgery! Since the lower abdominal skin and fat was already removed, the DIEP flap was no longer an option for her. She had enough upper inner thigh skin and fat for an inner thigh free flap – the TUG flap, which is our second-line donor site when the lower abdomen is not available.
Skin and fat from her upper inner thighs was transplanted as transverse upper gracilis (TUG) free flaps to create two new breast mounds. Six months later, smooth round silicone gel breast implants were placed to provide additional volume and projection.
Nipples were reconstructed using the natural standing cone that was created when the TUG flap was folded, and medical tattoo created two new areolar circles, using old photographs to help color match the hue and pigment to her prior areolas before mastectomies.
Follow up photos are shown 1 year and a half after her TUG flaps and 1 year after later breast implant placement under the flaps and nipple-areolar reconstruction surgery.
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
