Before and after bilateral delayed TUG (inner thigh) free flap breast reconstruction in a 42 year old woman. She previously was treated for breast cancer with a lumpectomy and radiation. She found out she was BRCA gene positive and elected to have bilateral nipple sparing mastectomies and implant reconstructions.
Unfortunately, she had a chronic infection of her right breast implant lasting years and creating painful contracture. She chose to have her implants removed and waited several years for considering a new type of breast reconstruction.
As she did not have much abdominal fat but had sufficient inner thigh fat (see the last set of photos for intraoperative images of her inner thigh flap markings), she was a good candidate for the TUG (transverse upper gracilis) free flap reconstruction. Skin, fat and a small amount of her gracilis muscle was taken microsurgically from her upper inner thighs and shaped into a projecting breast reconstruction.
The skin from the flap was removed and the entire well vascularized microsurgical flap was transplanted to the chest. Tiny blood vessels were sewn together to reestablish arterial inflow into the flap and venous outflow from the flap to the body.
The inner thigh scars lie slightly below her groin crease so that her labia majora is not pulled downwards, as can happen after a medial thigh lift. The thigh scar extends from the front of the thigh in the midline to the buttock crease in the back, where it is hidden. A thigh gap is usually created after the TUG flap!
She later had some fat grafting which complimented the procedure by removing stubborn areas of fat from her outer thighs and abdomen. Most of the fat that is transferred in a free fat graft gets reabsorbed. We offer fat grafting to our patients as a “bonus” after recovering from breast cancer, since the fat grafting donor site is essentially liposuction of whichever body part they choose!
Follow up photos are shown 4 years after her TUG flaps and 3 years after fat grafting. She is engaged to be married and is starting a new life, with her breast cancer far behind her!
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
