Inner Thigh Flap (TUG) Anyone?
Hi all.... I was wondering if any of you have undergone or know much about the Transverse Upper Gacilis Flap procedure being done for breast reconstruction.
I am interested in having my 9 year old silicone implants removed (upper body pain syndrome that I think is at partially the fault of my 400 cc implants - ) and having natural tissue used instead.
I met with a microvascular/reconstructive surgeon last week who proposed this method, as a good option since I do not have much tissue on the belly and need to stay as far away from my lumbar spine as possible having had spine surgery and ongoing issues with that.
I've done a bit of research and understand the shape of the breast tends to be very natural and projection is good from the inner thigh (even though I don't think I have much tissue there either despite my dr. saying I had enough to spare for a B cup size?)
I just haven't seen any ladies on the forums who have had this... and no real life photos except for some medical journal articles.
Would love to hear from anyone with experience or insight!
Thanks Much
RLS
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Hi
I had a TUG last October. the scar is long, but I'm ok with it. There is a bit of an indent in my inside thigh, but don't think anyone else would really notice it. I didn't have enough fat other places. The breast itself is a great shape - looking into some microfat transfers to add volume, but that is another topic. I found recovery to be pretty easy. Was driving within two weeks and pain was really no problem after the first couple of days. I think that it was probably easier than DIEP recovery from what I hear. I did have some twinges/pain after long flights or car rides and still occasionally do. Still can't stretch as far in yoga positions on that side. Let me know if you need any additional information.
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MsSerry thanks so much for that link... I appreciate.
Capqueen, I am so happy you are pleased with your TUG flap. I would be looking at having bilateral and am quite petite/thin as well. The surgeon I saw estimates a B cup which surprised. me. I like the shape of my thighs...so the scar and indent would be a little bit hard - but compromises must be made!
I really like that you had minimal post-op pain. I cannot take any narcotic meds at all due to a pancreas condition...do you think I can manage with tylenol and valium (what my surgeon has suggested).
You do feel tight in the adductor hugh? Did you do any kind of physical therapy for the restriction? Did they take an actual piece of the muscle (Gacilis)...or just tissue and blood vessels? I already have had lumbar spine fusion surgery and am tight in the legs to start...
Would you mind sharing with me who your surgeon was? Were you pleased with the care from him/her?
I have heard that the TUG procedure makes the very best breast shape in terms of projection etc. That's a plus! My email is rls1231@aol if you happen to have any photos you wouldn't mind sharing -- I'd be forever grateful!! You can write me regardless!
I am just so appreciative to have someone to ask about this ... seems most have had Dieps, Tram, GAPs etc... not too many TUGS out there.. and I don't think a whole lot of surgeons are trained to do them!
Thanks for whatever guidance you can lend!
RLS
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I will see if I can send a couple of pictures. Will have to work on that. Honestly, for me the sligtt indent is not a big deal. it is in the very middle of my inner thigh. If you look straight on you would only notice that ithe line is fdifferent on the two legs, My husband said he was really surprised by how good it looked. Not sure what to say about meds. I really wanted the morphine that first night, but was fine after a few days. I think it would be do-able if you were pretty tough, but probably not fun. The breast shape is exactly right, I used Dr, Allen. Happy to give you any other information that might be helpful. Just let me know.
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Capqueen thank you SOOO much. I really appreciate your sharing some of your experience with me. I have only encountered one other gal who has had the TUG... I wonder why not more.
Your recovery sounds amazing.... 2 weeks and driving ..and soon after on airplanes??? You did not have implant removal (as I will need) and you also had a unilateral - yes? That may be part of it. I know you said you get twinges of pain in the thigh area and can't stretch in yoga as far, do you feel that you have as much strength and support in your legs? The surgeon I consulted with said she may or may not use part of the gracilis muscle... depending if she needs the extra blood vessels.. I suppose Dr.. Allen did use the muscle for you?
Would you recommend Dr. Allen? I know he is the guru and invented the flap procedures... so I am sure he technically amazing... don't know much more about him though. Did he work with a partner? Was he attentive etc.? Was your surgery in NY or South Carolina?
On recovery, when you got home, did you have live-in help for a period of time... or not necessary?
Thank you sooo much for all your support!
With Gratitude,
RLS
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Happy to help anytime. You're right I had unilateral only (mx at the same time though). I asked about the muscle beforehand and was told they might need to take a piece, but that if they did I wouldn't notice. Didn't ask about it afterward. I don't notice any difference in strength at all. Just that I am a little tighter in stretches on that side - just from the missing flesh. Dr Allen was great for me. He has a low-key approach that works for me. I had two surgeries (clot had to be fixed one day after first one) and the assistants were Chen and LoTempio respectively. Really liked them both a lot. Everyone was attentive and supportive and available. Had the surgery in NY. Few issues at the hospital that I can tell you about if you decide to go that route. I had no special help after surgery. Once I got home from the hospital I was mobile and could do most things. Pain was totally fine by then. Everyone is different, but for me, this was no where near as bad as I expected. Wish the same for you.
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Also, did you get my pm and email?
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I did get the pm and email...and responded to both!
Thank you so much once again!!!
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Just reviving this topic again... simply because there seem to be so few ladies who have had TUG flap reconstruction and I'm wondering why. The 3 I have encountered have been very pleased....
Is it just a "newer" approach and one many surgeons haven't had much experience with yet? Or is there anything else that might make it less popular?
Thanks again to all!
RLS
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I have a question about the TUG,what size breast can you expect? I think I read small to medium...what would that be as far as A cup. B cup.etc? And please don't be grossed out by my next question, I have hair on my inner thighs,does a TUG result in hairy breasts???
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I am slim and small framed (105 lbs with 400 cc silicone implants in me!) and 5'1". My legs are fairly slim as well and I was told B cup ....which surprised me. There is something about the inner thigh that lends itself to different shape and projection. I'll see if I can find an article I recall that explained this. Not sure on the hair, but will you be needing to use the skin in your reconstruction?
If it is skin sparing mastectomy with reconstruction they will use your own tissue envelope for the breast. If you've had implants, I believe the flap goes within the skin that's already stretched. If you are doing delayed reconstruction and have had mastectomies already with tight skin over the chest you may need the thigh skin...or if there is radiation damage etc.
http://womensplasticsurgery.blogspot.com/2010/01/tug-inner-thigh-flap-microsurgical.html
This is a pretty comprehensive article on the TUG approach. Somewhere it says projection is often more than the natural breast ... something about the shape and texture of the flap from that location.
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Hi, After much deliberation between implants and a TUG, I decided to go for the TUG in July 2010 (in conjunction with a unilateral Mx). I live in Europe - where there are also few women who undergo this surgery - I think it is because it is fairly new, and not many doctors are skilled at it.
I was too slim for the DIEP procedure, and did not like the idea of having that huge scar running across my belly. I am a B-cup, and my doctor said he would be able to match that. He was wrong - I am now less than a B-cup, probably just between an A and a B cup. And he used the entire Gracillius muscle. The shape is very nice - after 6 months, it has settled close to the shape of my natural breast. It sits a bit higher, but this is not noticeable with a bra. I have an indentation on cleavage side, which does bother me. I may have it filled via liposuction. The scar on my thigh is well concealed - it runs around my bikini line to about half-way under my butt. Basically unnoticeable. I understand that in the US some doctors make the scar run down your leg, which seems quite strange and unnecessary to me.
It took me 6 weeks to recover till I could go to work, and then only at 50%. I did have help at home for the first 4 weeks, and was glad to have this, especially in the first 2 weeks.My biggest problems were riding in cars after the surgery. And as the scar ran under my butt, sitting for any time more than 15 minutes was also a problem.) I was very tired, but that was already my 5th Op in 3 months, so that probably added to the loss of energy. I still don't feel like I have the same energy I had pre-cancer/Ops.
I had quite some pain in my leg after the first weeks after surgery - and almost no pain in my breast. That changed after a couple of months, just the opposite. And now since about 2 weeks, I have a lot of pain in my leg again, and also in my breast. That may be from long days of standing and travelling within Europe. So think I have to take it easier now.
If anyone needs more infos from me, feel free to contact me. I'd love to hear how you're doing 6 months down the line . . .
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Hi Sarah
I am 18 months out from a unilateral TUG and don't have any pain at either site. I don't notice any difference in strength in my legs. I still have a tiny bit more trouble doing some "stretchy" yoga poses on the TUG leg, but nothing anyone else would notice. I did have a second procedure - fat grafting about a year after the TUG since I had some issues with clotting that caused some tissue death in the flap. That really made everything as perfect as you could imagine. Both breasts look almost identical. My scar is like yours (location-wise) and is still improving.
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What about SGAP? Because it is in the middle of your buttocks, it is not near the lumbar spine, but more in the area of the sacrum. And a good surgeon would listen to your concerns and take this into account. AND SGAP does not sacrifice any muscle. Having said this, though, there was another girl on here that I know had TUG with Dr. Allen and she was happy with her result. It may take me a while to find her name on the NOLA thread because I haven't heard from her for a while. I will look for it and maybe you can try to PM her?
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rls - her name is happy29 and she had bilateral TUG. I would try to PM her and see if she responds.
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Dr. Park at the University of Chicago also does the TUG procedure which is what she recommended in my situation: not enough abdominal, back or buttock fat and skin for 2 breasts. I'm not sure which way I'm going, but since I'm opting for delayed reconstruction I have time to think about it. She has a wonderful demeanor and spent lots of time with me discussing the various options and why they would (or in my case mostly wouldn't) work.
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I'm having a TUG reconstruction following a BM in the next few weeks.
I live in England and my MS learned this technique from the surgeon in Austria who pioneered it. I feel confident about the surgery although nervous about being in the hospital.
I can't have the DIEP because I had radiation to my stomach 17 years ago.
I suppose I'm most worried about how my breasts will look but I'm happy I won't have a tummy scar. I was happy to learn that my breast scars will be around the nipple and also, they can usually build a nipple as part of this surgery.
I will continue to write in about my surgery and my recovery.
Please anyone who has had this surgery, keep us updated as to your recovery.
TIA
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Hi I cant recall if you and I communicated before.
I had a TUG. It is a newer option for a muscle sparing flap so not many doctors know how to do it. I used Dr Allen. It was a great option for me because I too did not have enough for a DIEP and I did not want to compromise the shape of my rearend. Inner thighs worked great and now they look even better. It has a very natural cosmetic outcome. My scars are still visible (one and a half year out) but I can cover them up with boy shorts.I am grateful I had the TUG as an option. I am thrilled with my choice in reconstruction and have no regrets since I could not do a DIEP.
Happy
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I wanted to update my last post with my surgery date, which is the 5th of April. I'll be having BMX and TUG. The TUG procedure will be using the tissue including some muscle from my inner thighs. Hopefully, I will have enough for a B-C cup, which is what I am now.
I'm told I'll be in surgery for 8 hours and in hospital for a week.
I'll keep updating with my progress. I've seen so many pictures of the results of this surgery here in the UK and the results look good. Tomorrow night I'll be meeting other ladies who've had this surgery done - so hopefully I'll learn even more.
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Hi Lifelover
I am hoping your op will go well on the 5th. I, too am in the UK, and appear to have the TUG as the only realistic option for breast reconstruction.
I am scheduled to go in on the 18th of this month. This is is the first time I have felt slightly panicky about any procedure. My temporary implant following mastectomy is a grade 4 capsule and as hard as rock. Two consultants have warned me that it is unlikely that an implant will last or look natural so the TUG seems the way forward.
He has also given me the go ahead to fly to LA on the 11th May (just over 3 weeks after op) - does anyone else have a view on this? How did you feel 3 weeks after surgery? I had no problems at all with the two lumpectomies, the mastectomy, the chemo or the radiotherapy so why am I feeling so anxious about this procedure?
Good luck for the 5th.
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Hello, all. I am considering a TUG surgery. I see there aren't too many here with experiences but I'm wondering about choice of incision. My surgeon said I could have the vertical or horizontal incision. Not to be too vain, but I wonder which would be better if you wear swimsuits? The horizontal seems to run about an inch below a swimsuit bottom. Would the vertical be less obvious since its inside the legs?
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Hi
I had the TUG surgery with a horizontal incision. It is not visible at all in short "boy short" bathing suits. It would be visible in a bikini bottom. Also, since I only had one side done, in a bikini I think someone looking would notice a difference in the shape of the inner thigh (one being a bit more rounded). I have been really happy with this procedure and the results.
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I too am considering a TUG. I had a lumpectomy for DCIS almost two weeks ago, but two of the margins were very small, and the involved area was larger than expected. I am 46 years old, 5'10", 118 lbs, and about a 34A. After what they took out, there is not enough left for a re-excision. I've decided on a mastectomy and feel OK about that decision.
My anxiety is whether to get reconstruction at all, and if so, should it be a TUG or an implant? I am shying away from an implant because from what I gather, it will likely need to be replaced in 10 or 20 years best case. The plastic surgeon I am consulting has done 7 TUGs. I will see him on Thursday to grill him about this procedure, how his patients fared, and whether he can put me in touch with any of them and show me photos. If he could reassure me that my leg will be safe and unaffected in the long term, say, after a year, I would try the TUG in a heartbeat. I am fairly active and do a lot of heavy gardening that entails stretching, bending, squatting, lifting, etc. I also to hike and canoe and backpack. But I definitely would not want to compromise my leg in order to gain a breast.
Can someone who has had a TUG share a sort of comprehensive "recovery timeline," including time in the hospital, how long the drains were in, did you have a catheter, exercises you were given to do, how long did you need help with personal care, how long before you could manage cooking/cleaning/working, how long before you could sit for hours (I work on the computer a lot), how long did you have pain and at what level, how long before you could have sex? Are you content with how you look and feel? Did you need any followup surgery for nipple construction, or for complications? If the tissue didn't take, what happened next?
I am hoping to make my decision this weekend. Any first-hand experience, in addition to all I have read on this post so far, would be hugely helpful. Photos would be really appreciated if anyone feels they can share such a personal thing. One thing about being my size is that there are very few photos of women with bony sternum areas and small breasts. None of the lumpectomy/radiation photos helped me to project how I might feel about my body, and now that I'm facing a unilateral mastectomy, all I can think is that that I just don't want to look like a boy. My husband assures me that I will not look like a boy, no matter what, but I was sometimes mistaken for a boy as an adolescent, and some things tend to stick with you.
Thanks for any information and insights. All I can say is, thank goodness for being a woman and for finding a forum like this where women support one another.
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I am happy to help you in any way I can. Feel free to pm me. In general, I think I was really lucky. Although I did have some surgical complications, I really didn't have a bad recovery at all. I had a left sided mx with simultaneous TUG. I was back at work (desk job) in two weeks or so. I do work out a lot and was back to most athletic activities within 4-5 weeks. My TUG leg does not cause me any real issues. There are some yoga poses where I notice I can't stretch quite as far on that side. (sometimes have to use a block!) I am thin and was not a good DIEP candidate. Let me know what else you need to know.
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Does anyone know of any doctors in Southern California that does TUG well. I've seen some PS and they all only do a handful in their whole careers. Blue1, you mention flying to LA...can you share who you are going to?
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Hello,
I had TUG bilateral mastectomy in August 2009. The first 4 days were in the hospital being monitored to assure flaps will succeed. The next few days- I was sight seeing in New Orleans. The 2nd and 3 rd week were the hardest weeks for me. I think when the anestesia left my system, I could feel soreness and tightness in two major areas- inner thighs and breast area. Mornings were the hardest- just getting up and moving took 45 minutes and two pain pills.I had my drains in for I think 2 weeks. Milestone progress for me was at 4 weeks ,6 weeks 8 weeks and so on. By 12 weeks I felt almost 90 %. Early on Reaching is difficult and range of motion with legs and arms is tough. I also recall standing for a while on concrete and in general was tough! Sleeping - I needed many pillows to elevate legs and of course you sleep only on back.I needed help with two small children. I was back at gym after I think 8 weeks. A full squat takes a lot longer - like 6-8 months. Sex was tricky due to range of motion but doable after a few weeks. I continued to take pain pills as needed for 8 weeks. Like one in the morning and one if needed at night.
I opted for two additional surgeries to add volume and address fat necrosis. Scars on my legs are visible and I wear boy shorts in summer. Breasts look amazing (4 months post op last surgery so I am hoping they stay this awesome) My BS had to take cancerous nipple but made my nipple during initial surgery with thigh tissue. TUG is a great option is DEIP is not possible. My legs look slimmer now. I have no regrets. I just hope one day soon- micro fat grafting will be possible to totally reconstruct- that way women will be spared this major surgery. And make no doubt about it - it is major surgery.
Good Luck
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Wow, Happy, how far were you able to walk when you left the hospital?
I'm trying to get mentally prepared to be lounging on the lazy-boy while my vegetable garden and flower beds go on without me. I normally squat a lot while weeding. As long as I know I'll be able to do it eventually, that will get me through. So you CAN squat pretty normally now? When did the fat necrosis occur, and how did you realize it?
I'm glad that this worked out well for you and for Capqueen. Here's praying that it works as well for me and the others about to undergo it. I hope that Lifelover's surgery went smoothly.
Thanks for sharing. Knowing what to expect is a huge help.
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Louisa,
I was encouraged by my Doctor to walk . I am a very active person. I walked Alot. I was walking slowly but I remember it felt good. Week 3 was tough. I remember saying to my DH "what they heck was I thinking doing this? I should have opted for implants" I was emotional and mad at my great doctor. My DH reminded me that we knew short term it would be hard but long term this was the best option for me. and I do not have any regrets.
After the breast swelling went down, I felt fat necrosis. I could feel it (hardness)and I tried to massage it but it did not feel right. The necrosis was adressed at stage two. I have no hard areas now.
I can fully squat now- no problem. Amazing how the body recovers
oh I also formed a seroma during the second week at home. I was near my inner thigh incision. It was size of golf ball. I had it drained a few times but it kept coming back. Finally I ate low carb and it went away. Low carb helps get rid of all extra fluid your body does not need. It has helped through my surgeries.
Louisa, just make certain you have an experienced microvascular , plastic surgeon and that he/she has performed many of these surgeries. the surgery itself is important but the days after are Crucial. you need to be monitored closely to assure flap success.
Happy
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Happy, thanks for the extra info.
My plastic surgeon has done 8 of these and he said they have all succeeded. He is also a microsurgeon and does hands. Eight doesn't sound like a lot, but on the other hand it doesn't seem like it's a very common surgery, so maybe 8 is enough. From what I can gather, he is the best in our metro area. He is going to give my phone number to his other patients and hopefully at least some of them will call me. I met one already, and she was very helpful.
Regarding the fat necrosis, is it a dangerous situation? Does it have to be removed with another surgery, or just filled in? Do they tell you things to watch for as part of your discharge instructions?
Like you, I have to lose the nipple, and the PS said he will use thigh skin for that. But he said that the actual nipple reconstruction would be 3 months later. I'm not sure what that entails. I was already asking him a boatload of questions, so I let that one slide inadvertently. But he did give me his email address, so I will be asking him about that.
Also, thanks for the low carb tip. I love carbs, but I can do without if I know it will help me get through this with fewer problems.
Louisa2
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Hi Ladies,
I had my BMX and TUG last Tuesday and am now home - I only spent 6 nights in hospital. All my drains and catheter came out on day 4 post-op and I was using the toilet and showering on day 4. My last morning in the hospital I showered myself, walked up and down a flight of stairs and was sent home! I am amazed at my experience and my new beautiful breasts. My story (not all easy follows).
The surgery was grueling. It is major surgery and the first couple of days were very difficult and draining. I, however, did not need major pain meds - I only took an over-the-counter pain med and antibiotics along with a blood thinner injection they give everyone. I was under anaesthesia for about 14 hours as I had to be taken back into recovery soon after the mastectomies and recons were completed due to a hemotoma in my left thigh donor site. I was observed for possible blood clot in my lungs because my pulse was so high and was in the uncomfortable position of having a CT scan soon after surgery when they couldn't get my pulse down. It appears that I am someone who is tacycardic and just never knew it. The only problem found with my lungs was that my lower lungs had slightly collapsed - I was given a spirometer to practice my breathing and this soon solved my lung problem.
So, you see Ladies, even with having a few complications as I did, one can still recover quite quickly.
My plastic surgeon did a beautiful job on my breasts and all the surgeons and students who came to see me several times a day (as they do in a teaching hospital) were quick to confirm this. He is one of the top surgeons in the world but he is based in the UK. His name is Venkat Ramikrishnan. He is an NHS (socialised health care) PS as well a private one. My breasts are round and perfect with big (they are big at first) nipples. The scars are only around the aereola and then one line from the aereola to the nipple. One of the benefits of the TUG is having the possibility of them being able to build nipples from the cone of fat, muscle and tissue they take from the inner thighs. There is some bruising to my breasts but very little discomfort.
As far as my thigh scars - these are uncomfortable and it is difficult to find a comfortable position in bed and quite grueling to sit on the toilet. You absolutely cannot use your chest muscles to get yourself up or down or anywhere! So your stomach and thigh muscles become very important and will soon become very strong if they aren't already. Right now I'm quite swollen all over and so my scars are very tight. The swelling will eventually goes down when my body calms and detoxes but right now it is difficult to bend down. I can walk fairly far but if you have a bad back, you have to do this carefully and learn to tuck your bum under your hips so you don't put your back out - and this is difficult to do with the pulling of the stitches in the thigh scars.
Okay, so what have I left out?
:0I saw BMX/TUG patient of the same surgeon. Her op was in December. Her thigh scars are amazing. They are thin grey lines and to me, they look from behind in the bum area like shading of a well-rounded bum. From the front, it is more obvious but I can't wait to see what happens to me in a year's time.
Gosh, it seems I've written a book here. Sorry. I hope this is of use to some of you.
I will be posting my before and after pictures on TimTam's site. My DH is taking my one week post-op pictures tomorrow and we'll get them on TimTam's site in a few days.
Please don't hesitate to ask me anything or send me a private message.
Best of luck to those of you off for surgery soon.
I've got so much to catch up on and am so excited so forgive me if I'm not being personal enough
I
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