7 - Free Transverse Upper Gracilis Flap Breast Reconstruction

Abstract

The transverse upper gracilis (TUG) flap provides a suitable alternative to standard microsurgical reconstruction techniques like the deep inferior epigastric artery perforator (DIEP) flap and implant reconstruction. The unique design and tissue characteristics of the TUG donor area provide for natural flap folding and superior breast shaping. The flap anatomy is straightforward and operative dissection time is expeditious for the experienced microsurgeon, while tedious perforator vessel dissection is not necessary. Patients with small and moderate-sized breasts can be good candidates, provided they have adequate inner thigh tissue. The typical patient is pear shaped, with excess thigh subcutaneous fat, and in need of an A to B size cup reconstruction. The TUG flap can be used in both immediate and delayed reconstruction, with or without an externalized skin paddle and can be combined with later implant augmentation or fat grafting to increase size. Disadvantages include the need for microsurgery, difficulty in assessing volume preoperatively and the donor scar.