There are several breast reconstruction methods that use skin, fat, or muscle to form a “tissue flap” that helps recreate the breast.
TRAM flap ( Use of muscle and fat from the tummy) was a very popular reconstructive option some years back. This is now mostly replaced by advanced microvascular techniques ( DIEP Flap) which do not disturb the muscle in the tummy and uses only the fat and the skin.
Most women have enough extra tissue in their tummy area to create a new breast.The DIEP flap (deep inferior epigastric perforator) is a tissue flap procedure that uses fat and skin with its own blood supply from the tummy to create a new breast mound after a mastectomy. The removal of skin and fat from your tummy is similar to the procedure for a tummy tuck (abdominoplasty). Abdominal muscle will not be cut or removed for this procedure. Additional minor procedures like tattooing and nipple reconstruction will be required.
Some women who request autologous breast reconstruction (using their own tissue), are too slim and do not have enough fat tissue in the lower abdomen to perform a DIEP flap. Others may have had a surgical procedure in the past to the abdomen, which has led to scarring. These women may be able to have a Transverse Myocutaneous Gracilis flap, known as well as the TMG or TUG flap.
TUG flap microvascular breast reconstruction is an excellent option for patients who desire autologous reconstruction and who do not have adequate abdominal donor tissue or who do not desire abdominal scars .In this procedure, excess skin and fat from the inner portion of the upper thigh is used to create the new breast. Microsurgical techniques are used to reconnect the blood supply. The flap is constructed with a semilunar skin paddle centered over the long axis of the gracilis muscle in the inner thigh . This flap can then be shaped to mimic a breast and provide excellent contour and projection with a consistent blood supply. TUG flap allows for immediate nipple-areola reconstruction in both immediate reconstruction following skin-sparing mastectomy and in delayed breast reconstruction alike. This form of reconstruction usually improves over time.
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