The TUG (transverse upper gracilis) flap uses the gracilis muscle, located in the upper inner thigh. This muscle starts at your pubic bone and ends along the inside of your upper leg. The gracilis muscle helps you bring your leg toward your body. It’s important to know that with TUG flap surgery, you will no longer be able to use this muscle.
During TUG flap surgery, a flap of skin, fat, muscle, and blood vessels from your upper thigh is used to reconstruct the breast. The flap is moved up to your chest to rebuild your breast. Your surgeon carefully reattaches the blood vessels of the TUG flap to the blood vessels in your chest using microsurgery.
The TUG flap may be a good reconstruction choice for women who aren't good candidates for TRAM, DIEP, or SIEA flaps because there’s not enough donor tissue in the belly area, or they’ve had previous flaps that failed and are seeking a secondary alternative.
The TUG flap may be a good option for women with small-sized breasts. If you have larger breasts and your doctor recommends TUG flap reconstruction because of your unique situation, you'll probably need a saline or silicone implant to achieve your desired size.
Because skin, fat, and blood vessels are moved from your upper thigh to your chest, having a TUG flap means your thigh will be tighter — as if you had an inner thigh lift. If TUG flap surgery is used to reconstruct one breast, there can be some unevenness in the thighs. If you want to avoid this, talk to your surgeon about other options. (A newer type of DIEP surgery, called “stacked DIEP,” is often a good option for women who don’t have enough belly tissue for a standard DIEP. However, this surgery is not widely available.) If you’re having both breasts reconstructed, though, your surgeon would take a TUG flap from both thighs, which means both thighs would be thinner. TUG flap surgery is possible even if you’ve had previous liposuction on the thighs.
A TUG flap procedure leaves a scar on your upper inner thigh, but most surgeons will usually tuck into the crease at the top of your thigh. In some cases, the scar might be a little lower and may be visible when you're wearing a bathing suit. TUG flaps do tend to have more healing problems at the donor site than other flap surgeries due to the location of the incision.
Learn more about TUG flap reconstruction on these pages: