Inner Thigh Flap (TUG) Anyone?
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Lifelover, Thanks for the reply and information.
To all of you, I am now 37 days post op on the PAP. And while I was doing overall well for the first 4 weeks, my trajectory of improvement has slowed and I'm dealing with draining incisions and some occasional pains in the inner thigh that were not there before, and that I was not expecting. In addition, I am realizing that the superficial numbness I have in some areas (a small strip down the back of left thigh and the calf may take a long time to heal. So, I am just sorting through set backs and doing my best to remain positive. By the way, I am posting a link that talks about the difference between the TUG and PAP. This is not where I had my surgery, just an informative site:
http://www.constancechenmd.org/TUG-PAP.html
Janet, I think having realistic expectations helps a lot. For example, I expected tightness, so was able to deal with that better than numbness. As for breast size. I wore a 36 A bra, but PS said I was a B. If so, I'm the smallest B I have ever seen. He measured 7 cm. down my inner thigh to get the cresent flap. I'd say I came out looking like what I considered a B and after the swelling went down - after about 4 wks - I went to what I consider was my normal size (to me an A, but to PS probably a
. I mention all of this b/c I remember somewhere you asking about size. My breasts look very good overall. One is about 40 grams less than the other. Which can be corrected during stage 2 if I decide to do that. That's a tough one b/c if I was born 40 grams less, I would never be the one to go in for such a surgery, but we'll see. I'm not even thinking much about that now, only healing well from stage 1. As for you, I pray your surgery goes well and wish you the very best in recovery. Do you have a date yet? If you posted it I can't remember. Oh and at the same link I sent, they mention pre and post op suggestions that look pretty good.Wishing you all well on your continued journey. (((HUGS)))
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Just a note about the tightness feeling - it will eventually go away with movement and time. And some gentle exercise once you're ready for that.
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Stac thanks , I'm sorry you are having a problem so far out from the surgery. That seams to be the one problem with the thigh surgery is the healing in that area.
I am now a 34D and it will take some getting used to if I become a B. I have a ton of bras and bathing suits, So I hope they will still fit. I have had implants for 22 years. 16 just cosmetic and 6 reconstruction fom BMX My implants actually saved me from having radiation. The breasts shape from implants to natural is very different in sizes. My one wish is that they make the pocket smaller or they just won't look right. I go in on March 6th to go over everything with the surgeon. He said he usually does the nipples on the second surgery but I don;t want one if it can be avoided. He says it will depend on the surgery and make the decision than.
I think the thing that bothers me the most is some of the people I have spoken to have said well this is cosmetic surgery so matter of fact. It kind of pisses me off. I think unless you have gone thru it you can't understand. We all make the choices that are the best for ourselves.
But for now I will just concentrate on the surgery. I go in on March 14th.
Thanks again to everyone and your support, Janet
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Janet,
I think it is cool that you are asking all the questions to get informed as well as asking for what you want from the Drs. After having been through all you have already you know YOU are your best advocate. Let us know how your appt. and surgery go and if they make a smaller pocket b/c to a novice in all of this that sounds like a good idea.
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Janet, your PS should be able to tell you what size he can get from looking at your thighs. Mine told me he could get the same size as I was, and he actually got slightly bigger, but I had a good supply of donor fat! That's one place I always had extra.
My incisions are 5 inches down the inner thighs. Part of the incisions healed very well. If you imagine drawing down your leg with a white pen, that would be what most of it looks like. But I do have about an inch long place on both legs where the stitches must have popped open a little and it scabbed over. So those two parts of the scar are wider. If I stand up in a bathing suit, I don't think anyone would notice my scars. As far as the breast scars, mine are just round where the areola would be. If I get the tattoos, I think it would be hard to see those also.
I did rub some aquaphor and later cocoa butter on my incisions once they were healed. I'm not sure if that does anything or not, really. And I wore my spanx for a long time because it ended up feeling good to wear them. IBut I couldn't stand to wear them at night because it was too warm. Definitely wear them as long as the plastic surgeon recommends.
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Twohobbies, i have quite a bit of extra leg also. I'm thinking a C's worth. Thank you for sharing. My Dr wanted to do the scar down the leg also. I need to look at pictures when I see him. I may go with the horizontal scar. I have saggy skin on my inner thigh so I'm hoping he can get a nice piece without having to worry about to much tension.
Thanks Janet, hope you are doing well
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When you have your MRA done,I think they can estimate the size breast you can expect.Go to www.julievasilemd.com and go to the blog notes of interest..it says they can estimate with DIEP,so seems it would also work with other donor sites....
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Boy, lots to catch up on. What was I thinking when I kept lobbying for a new puppy? She keeps me tired all the time, and the poor cat--queen of all things--is not pleased. So, let's see if I can respond to Stac and Janet to add to what Lifelover, TwoHobbies, and others have said.
Stac, about the numbness, I never had it in the calf. I would say that at first it was maybe about halfway down the back of my thigh, and also around to the outside, even past the end of the scar. Over time it has decreased, although I still have an area where I can't feel anything. I'd guess that it's about a 2-in. band directly beneath the scar in the back. As I trace my finger further away, the sensation gradually increases. The front never had numbness. I thought it was kind of freaky too, but now I am actually surprised by how little it actually bothers me. I really only notice it when I'm dressing, or leaning against something.
My legs are definitely not as strong as before the surgery, but I think that's because I was pretty active before, and then had about 3 months of lying around and only minimal walking.
I wore the compression shorts for about 3 months, until my final checkup with the PS. I don't think I needed to wear them that long--I remember him saying something like, "Oh, you're still wearing those." Having 2 pairs was great, so I always had clean ones. Insurance paid.
Size--I am 5'10", and was 118 lbs. at the time. (I gained 10 lbs. in the 2 months after my surgery, and the puppy has been helping me get it off. I don't mind "128," but it was all around my middle and all my pants were tight.) I am probably a 34A, although a lot of my bras are 34 or 36B and I don't quite fill them. When I raise my arms overhead, the tissue in the new breast is a little fuller up toward the armpit than my natural breast. There are also two small "hollow spots" that appeared at maybe 5 or 6 months post-op. They bothered me at first, as did the rather large necrosis area (maybe about 4x5 cm, the oncologist told me). In clothing, even a bathing suit, I don't think anyone could notice anything different about left and right.
I have gotten used to all this, and barely think about it anymore at all. It might help that my eyesight is terrible, so when I am showering and drying off in the bathroom, I really can't tell a difference in the mirror!
When I do think about it, I am mainly really, really happy not to have to mess with a prosthesis. That was my main reason for having the surgery. That, and having such a bony sternum area, I was really afraid that if I did not do recon, I would look half skeletal. I couldn't find any pics of anyone build like me. (I keep meaning to post pics of myself on TimTam's site, but just have not gotten around to it.)
My thigh scar is fading. The front looks better than the back, but the back is in my butt cheek crease, so only visible if I bend over. My PS did not go down my inner thigh. I think he said that the flap he removed was about 3 x 11 inches, in that sort of fat horseshoe/boomerang shape.
God forbid, if I ever need to have the other side done, I would do it again. But this time I would insist that they image the blood supply in my thigh first. I asked my PS about it and he said they do it for the abdomen but not for the thigh because it's usually more predictable. Not sure if that was the word he used. But I do have to wonder if my necrosis is related to that, or possibly related to the fact that my surgery was at a teaching hospital, so I don't know who all worked on me.
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Janet, I forgot to say that I completely agree--you need to do what is best for YOU, regardless of what anyone else thinks. About size, the only discussion I had with my PS was that I didn't want to revise the healthy side, and wanted him to match that. And he said I had enough inner thigh tissue to do it.
Depending on one's own outlook, I would encourage women to wait at least 6 or 8 months, or even a year, before deciding on revisions. Your body will have settled completely by then, and you will have gotten used to things--or else be sure that you definitely want to proceed. At my last checkup, 3 months post-op, I was pretty sure that I would do the microfat grafting to address the necrosis, and have the nipple construction, over the Christmas break. But it became less important to me, and the idea of avoiding a surgery was appealing. I might still do it, but I think I might wait even a few years. Who knows? Maybe by then the fat grafting will become a more sure thing and require fewer procedures.
Good luck as you proceed through this major life event. Once it's behind you, things will only get better! : )
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Lifelover and TwoHobbies, a few gardening notes! Our mild winter has led my Diane witch hazel to bloom about a month early. I've also got some hellebores and winter aconites blooming. I hope you're both doing great and that 2012 is a great year for you!
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Hi Louisa! We had a lot of warm weather here until about a week ago. Since then we've had snow on the ground and cold, cold temperatures. That means everything has stopped growing like the grass. Time to propigate seeds here and my sweet peas are waiting for me!
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Hi Loiusa,
Thanks for your detailed reply and it is so good to hear from you. I know what you mean about the puppy. We got one at the initial stages of the cancer roller-coaster and he provided a great distraction for 3 weeks, but our older dog of 10 years never acclimated to him (understatement) and so we posted him on craigs list and gave him up to another family. That was hard, but it was the right decision for us and our big dog who was being tormented. How are you doing overall as I know the journey has been a tough and long one? Also, as to the necrosis, how did you find it and can you tell by looking? Does it stay or get removed?
To all of you,
I noticed you posted about gardening some. I don't know if any of you appreciate birds as well. I live in the Dallas area and had a flock of Cedar Waxwings land in our yard yesterday which was a pleasure to watch. They came in to eat the berries off our crab apple tree.
Overall I am doing well. I went back to work last week, 6 weeks post op and it was just the right time for me. Work went well and it was good to be back. On the down side, I have a pain in my left inner thigh that makes it hard to walk sometimes. I'll do well for a week and then it re-appears and when I have to walk, I do so with a limp and take it easy and it seems to go away only to reappear again a few days or a wk later. Did any of you have this? If so, was it off and on and for how long? No matter what I tell my Dr., he just says give it time, but I like to understand things and do what I can to help it heal if anything.
So How are you all doing on pain and infections as I read a lot on your previous posts about that. I hope the pain is reducing or gone and the infections are all gone by now. Wishing you all well and hope to hear from you.
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We have had a mild winter too, but not so mild that anything is blooming. However, I like to hear that somthing is blooming a month early where Louisa is. I would love to see spring come a month early. Last week it seemed so mild and springlike I thought maybe I could plant some cold weather plants soon. Now we too have a cold snap that reminds me winter is not done yet. I definitely look forward to spring and being able to do everything this year. Stac, I feed the hummingbirds in the summer and this winter I got a squirrel-proof feeder. So far I see the usual characters around, cardinals, chickadees. I can't wait till my hummingbirds come back.
Louisia, rambunctious puppies can wear you out but they are such good companions and walking buddies when they get settled. We had a big, one year old dog staying with us when I got diagnosed and I have to say, I was so glad when he went back home. Our dog is smaller, well behaved and so low maintenance compared to that young, energetic, big dog.
Stac, glad to hear you are doing well getting back into work. I went back at six weeks too and it was pretty hard. I know I was walking and sitting pretty gingerly at that time. I think sometimes you can get out of whack when one part hurts, you end up walking or sitting differently than you should. Hopefully that's all it is.
My biggest complaint at this point is fatigue. Does anyone else still have that problem?. I get up at five to go to work, which probably doesn't help. Most days I go for a walk for 20 to 40 minutes, depending on the weather. So I'm functioning, but I'm pretty tired all day and some nights I sleep 10 hours still. Originally my doctor said it was the anesthesia, and I don't react to anesthesia very well, so I could see that. I sure hope its not tamoxifen. If its the tamoxifen this is going to be a long 4 1/2 more years. I go back to the BS in March, so maybe she'll have some answers.
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Two Hobbies,
Good to hear from you! Yes, my neighbor feeds the hummingbirds and I get the pleasure of watching them show up each year and sometimes take photos. Since I haven't had chemo, radiation or Tamoxifen, I haven't had to deal with all of the potential side effects that come from all of that. But I do sleep at least 9 hours each night and that preceeded cancer and I call it being good to myself b/c that is what my body prefers. Man, you get up early. How cool that you are walking when you can! I know fatigue has to be wearing on you and hope you hear from some of the others who have been through some of the same things you have. I don't remember what part of the country you are in, but it sounds like you are having similar weather. One thing I like about Texas is you never know the weather from one day to the next, but more often than not it is hot. And when it is cold it doesn't last for long. My big dog is like me, we both look for where the sun is shinning and try to linger there for awhile. Wishing you well.
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Stac, I am from the Chicago area. It seems a lot of the country has had a milder winter. To us, a mild winter means only a couple of bad snows and a lot of upper 30s, low 40s. Not the same as yours, I'm sure. That would probably be a bad winter for you!
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Two Hobbies, Yep you are right on the weather. When I think of Chicago I think of Gino's East Pizza, Amtrack, and Cool downtown area. We've had a drought, a mild winter, and just in the last few weeks our lakes are starting to come back up with the rain. Since we spend a lot of time on the lake (and its good for the vegetation, water supply etc) that is something I am glad to see happening.
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Ladies, I'm going to have to temper my spring fever. We have 6 to 8 inches of snow predicted. Stac I'm willing to send you some, you know - to fill up your lakes.
So the only thing blooming in my life is cut flowers from the florist and my orchid. That will have to do for a while.
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Hi girls it's Janet. I had my talk on the 14th and I was in the hospital for seven days. I had a rough time with the anesthesia but I did have eight drains and the catheter. They put some sort of vacuum on my thigh incisions. My doctors are very pleased. I came home with four drains. I going to see him on Monday. The doctor I went to was very good. He likes to do a horizontal and vertical scar. I did explain to him that I did not want the vertical scar. He felt he needed to do it for volume I was going to accept less volume. Before I went into surgery I did say that I would except a 2 inch vertical scar along with the horizontal. When all the bandages were removed on Monday I found that it was a five Inch scar vertically. My anxiety was so high I finally got in touch with him yesterday. He tells me he doesn't remember any such decision being made. I have had so many surgeries that I do know what I want. These doctors are so consumed with more volume and cleavage and the funny thing is is that I wasn't interested in that. I would've been so happy with a small perky breast with less incisions on my thighs.
I do know one thing that everything takes time and I have to give it that.
One question for the ladies that had the tug. How long did it take for your swelling to go down.
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Hi, Janet. Sorry about the incision. I've never heard of doing both vertical and horizontal, but maybe your thighs are not as fat as mine! I will tell you within 8 or 9 months you really cannot see mine hardly at all. At first they are quite red and pink but then it all fades to white. How do you like the breasts? I know you may not care right now, I didn't really care at first.
I do not exactly recall how long it took the swelling to go down but I would say at least 6 to 8 weeks in my case. I wasn't wearing my compressions at night and the doc said I should try, so maybe that's why it took so long. But after wearing them all day, I couldn't stand to sleep in them!
I have such a tough time with anesthesia too. I hate it! I hope you are feeling not too bad and getting around OK.
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Thanks two hobbies for getting back. At this point I'm not wanting to look at all. I'll keep in touch may post pictures sometime in the next couple weeks. Janet
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Hi Janet,
Congrats on putting the surgery behind you!
I didn't look at myself in the mirror for a long time. My sweetheart Dave kept telling me how amazing I looked. When all finally settled I was very pleased with what I saw. I hope you can come to terms with your "new" look.
I just want to remind you to keep your scar areas as clean as you possibly can so you don't get any infections. Particularly important when you are on the toilet and wiping yourself.
And wear the compression shorts even when you feel like screaming to have them off. I had swelling for months because I didn't want to wear the shorts.
I'm almost one year post TUG now and I'm very pleased with the way I look. My scars did not heal well but my PS says my case was unusual. I wasn't a good scar healer. Anyway, they are still fading and I undress at the gym and go swimming in my one-piece suit and no one screams! Tee hee hee.
Oh yeah, although I still have numbess in my breasts and thighs, I can still do low impact aerobics and weight lifting (light) like the rest of the ladies in my gym classes. So, really, I've returned to normal for the most part and I am so happy with myself!
Janet, I hope you keep healing well! Best wishes to you.
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Janet I was just looking back at some of my old posts, which is probably more accurate than my memory! I'm not sure if you were asking about leg swelling or breast swelling but I was still having some foot and ankle swelling at 3 months that would subside at night but come back during the day. Did they tell you to "keep your toes above your nose?"
And I second lifelover's advice about keeping clean. I got an infection and had to go back in the hospital.
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I had my pre-assessment at the hospital yesterday for liposuction to fill the top portion of my breast that has caved in a bit. I'm waiting for a date now.
I'll need to have anywhere from 2-3 surgeries as they will only take a small amount of fat from my outer thighs at a time. Doctors say this is to ensure that there is not an over-filling. Apparently they wait to see if and how much the body absorbs before scheduling the next surgery.
The surgery is done under general anaesthesia and requires one night stay in hospital.
I'm excited about having my breast filled out but a bit scared about having surgery again. Still, I'll try to keep my positive attitude throughout!
Hope you are all feeling well and recovering quickly.
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Lifelover, best of luck with your next steps! You have been such an encouragement to me and others, I'm sure, with your perseverance, positive outlook, and humor.
I have a little bit of cave-in too, but it is not too bad, as it is mostly covered by my bra, and I am probably only an A, and my sternum area is kind of bony anyway. I have been really enjoying truly not thinking about the whole breast thing for quite a while now.
One day, about 10 months post-op, I realized that I no longer have that that odd sensation down my inner thigh that I could only chalk up to "things resettling themselves" after the gracillus muscle was removed. And when I squat, which I do very frequently in the garden, I reall truly do not notice any difference in flexibility or comfort between my TUG leg and the other. I do still have numbness in a band across the back of my thigh below the scar, but no big deal.
Next up, I'm thinking about retrying Tamoxifen just to see how it goes.
Stac, sorry I'm just catching up now and saw your question about my necrosis. You can't see it, but you can feel it. I had it pretty much from the beginning--there was an area of my breast that was a little more firm than the rest, even when I was in the hospital. The surgeon said that part was fat from the back of my thigh, which he said tends to be firmer, and that it should soften up over time. But it never did. In subsequent checkups, they have "measured it" and it is pretty big, about 4 x 4.5 x 1.25 cm. At first, I sensed it frequently, like when I held something against my chest. I was sure that I would have surgery to remove it and replace with microfat grafts. But I gradually got used to it. And, like Lifelover said, it would take multiple surgeries because they can only graft or transfer (or whatever it is they do) a little fat at a time. So right now I'm just ignoring it and being oh-so-happy that I don't need to worry about a form. I don't ever have to have it removed if I don't want to. I had my first mammogram last month, and I asked them to do the reconstructed side, even though they don't normally, just because of the lump. They also wound up doing a sonogram. The necrosis was bizarre looking--some of it looked like a cyst, with a dark center. The doctor told me that it is basically fat, and some of it is hardened and some of it is more soft, toward the liquid end. Very strange, but at least I now have a baseline in my file.
I hope you all are doing well!
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Lifelover, I had a little fill to the top of my breasts in December when I had my nipple surgery. They look really good. The sugery is a piece of cake to recover from compared to what we already went through. But I didn't much enjoy the anesthesia. I think that was contributing to my fatigue that I complained about for a couple of months. I feel much better now.
Louisa good to hear from you. Its nice to not think about the breast thing, isn't it? I have to go to the breast surgeon for my check-up soon and I don't even want to go. I'm enjoying no doctors for a while!
Stac and Janet, hope you are doing well, too.
I realized a couple of hours ago that one year ago today I had my surgery. What a journey. Glad to be on this side of the year. Last year I pretty much missed spring, this year I've really enjoyed it. I was thinking about planting a tree or something as a commemoration, but I haven't decided what yet, or how I'll talk my husband into it.
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Great to hear how well you are both doing Two Hobbies and Louisa!
1-year post op and I am able to do aerobics classes! The missing gracilis muscles do not seem to affect me at all! My instructors say I'm doing well keeping up with the others in the class!
Yes, spring is beautiful this year.
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Two Hobbies, Louisa, and Lifelover,
Good to hear updates on each of you and I always appreciate the info. My inner thigh pain stopped at about 10 weeks, soon after removing a three inch and a two inch suture from a nearby area. I was able to resume tennis at that time and have been doing well overall. I am at about 4 months post op now (on the PAP) and for the last few weeks have had some blister-like areas on or near about half of my left thigh incisions that will not go away. So I am meeting with a local PS in a couple of weeks. I think these are also caused by sutures that are poking, but that haven't made it all the way to the surface. I dread the thought of going back in the hospital right now and wish he could just do something in his office, but I know that is unlikely. When I emailed pics to the Dr. who did the procedure he said that area probably needs to be cut out and restitched (he's a PS, but not local). I'm not really ready to think about stage 2 (especially since I had NS and SS). I'm fine with how my breasts are now. Its just getting this thigh stuff healed. Wishing each of you well. I am enjoying this beautiful Spring too!
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Good for you Stac! It's inspiring to hear others are exercising and healing nicely. Take it a step at a time. My swellings took a long time to heal but now my thighs look great. I hope however they correct your blistered areas it is not traumatic or painful for you.
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Take heart . Don't let all this info. scare you off.
I know how overwhelmed you feel. I felt like I had been kicked in the stomach when I first researched TUG and read these forums. It takes a while to absorb the idea and not just recoil. True this is a 2 step procedure, but the reality is there is no procedure available that is only one step. They are ALL staged. Yes, the first surgery is a big one for sure,but the 2nd is just an outpatient procedure - nothing like the first.
Having gone through the entire painful implant reconstruction process last summer (2-step plus lots of painful fill-ups ) only to have them fail, one at a time, requiring 2 additional surgeries, I am ready to do anything to avoid implants again!
While educating myself on TUG I came across a more recent procedure called PAP. It uses a different artery , the profunda artery, and is muscle sparing. The incisions for this surgery start in the back of the leg below the crease, and continue around on the inner thigh to part way across the front of the thigh, but not down the leg . (check postings of amac645 who recently had a TUG on one leg and a PAP on the other.
I am scheduled for a bi-lateral PAP in July with Dr. Robert Allen, but though I met with him in Charleston my surgery will be in NYC. He's the doctor who invented most of the flap procedures now done, and has been responsible for training most of doctors who perform them. He operates and teaches each month in New Orleans and NYC, so the largest proportion of the microvascular reconstructive surgeons can be found in those 2 cities.
I am very happy, though, to inform you that Florida has an MD Anderson Cancer Hospital, and that there are two surgeons there who perform TUG and If I remember correctly one is a Dr. Lee.
So - just take a deep breath and allow time for the idea sink in. Also, check the posts from amac645. She is about a month out from TUG on one leg and PAP on the other and is breezing through this whole thing! Reading her posts has greatly allayed my fears , and I am sure will do so for you as well.
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Hi everyone, it's been a while. I am recovering from my tug. It's been a long road. I ended up with a staff infection three weeks after the surgery. It ended up deforming one of my breasts.
I went in for my second surgery May 14 th. he was able to fix it add fat and nipples.
My legs are much thinner and im very happy with them. My breasts have been harder to get used to. My husband thinks they look great.
This process takes patience and time to except your body changing. I also haven't worked out in three months and everything has turned to flab.
In between all this they found a mass in my uterus. I am going in for a D& C and biopsy.
I'm having a tough time feeling no end to this. I just hope it comes out well and I don't have to go for a hysterectomy.
Shit breast cancer can suck.
There will be an end to this. I am feeling better
Hope you are all doing well.
Janet0
