Before and after bilateral breast reconstruction using the inner thigh TUG flap in a 40 year old woman. She had a large right breast cancer that required removal of her right nipple and surrounding skin. A left prophylactic nipple sparing mastectomy was chosen given her age and aggressiveness of her tumor.
She knew she did not want implants and specifically sought out a Microsurgical breast reconstruction. She was a candidate for either a DIEP flap or a TUG flap. Given that she had more inner thigh fat than belly fat, she chose the TUG flap as her breast reconstruction, as she did not have as much tummy fat as inner thigh fat.
Bilateral mastectomies were performed at the same time as transverse upper gracilis (TUG) flap free tissue transfer breast reconstructions. Skin and fat were harvested from her upper inner thighs. A majority of tissue taken is from the back of the thigh, as can be read about in more detail in the description of the steps of TUG flap surgery.
Her right breast reconstruction required a skin paddle to be left in place of the nipple and areola, which was removed by the breast surgeon. A second stage procedure reconstructed her right nipple and areola via “nipple sharing”: half of the left nipple was transplanted as a free nipple graft to the right side.
With nipple sharing (which is the BEST way to reconstruct a nipple when a good sized nipple is present on the other side), the “donor nipple” becomes around 50% smaller, and it retains sensation. The “recipient nipple” looks like it was always there!
Tattoo was done on both sides during her second stage (and final) procedure. This created a new areola on the right and enabled the left areola match in color, hue and intensity. Free fat grafting improved the appearance of her belly and flanks while adding a small amount of volume to her breast reconstructions. This second stage procedure gave her a “Mommy /Breast Cancer Makeover” as well as restored her body image after pregnancy and having breast cancer at such a young age.
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
