Before and after bilateral nipple-sparing mastectomies and immediate breast reconstruction using the transverse upper gracilis (TUG) flap in a 65-year-old woman with breast cancer. This patient felt strongly she did not want to use implants for reconstruction, despite being a good candidate. She did not have enough tummy tissue available for a DIEP flap, so her inner thighs was our next option.
Skin and fat based on blood vessels from the deep inner thighs and a small segment of gracilis muscle was isolated under loupe magnification and then transplanted, free in the air, as a free flap, to the chest.
One tiny (2 mm) artery and two accompanying 2-3 mm veins were reconnected using hand-sewn anastomoses under the operating microscope. The last image shows where the inner thigh tissue was taken from in the upper inner thigh region – the dots below the markings show additional fat that will be included with the flap.
Follow up photos are shown 5 weeks after surgery. She will begin chemotherapy back in her home state soon. She is very pleased with her reconstruction, which resulted in fuller breasts than when she started!
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
