Women who do not have an adequate amount of abdominal tissue for reconstruction may be eligible for GAP (gluteal artery perforator) flap breast reconstruction. This procedure uses excess skin and fat from the gluteal (buttock) region and leaves all the gluteal muscle behind. Like the DIEP flap all the patient’s muscle is left in place to preserve function and make recovery easier.
Dr. Chaiyasate may take skin and fat from either your upper (“superior”) or lower (“inferior”) buttock region. These are referred to as the “SGAP flap” or “IGAP flap” respectively. Both incisions are easily hidden with underwear.
The TUG flap procedure uses tissue from the inner portion of the upper thigh (just under the groin crease) to reconstruct a “natural”, warm, soft breast. The resulting thigh scar is generally very well hidden near the groin crease. Patients also receive an “inner thigh lift” as an added benefit of the surgery.
The TUG flap is a very good option for women who:
- have small to medium sized breasts
- want to avoid an abdominal scar
- do not have enough abdominal tissue for DIEP or SIEA flap breast reconstruction
- have had previous abdominoplasty (“tummy tuck surgery”)
- have had multiple previous abdominal surgeries
The procedure uses skin, fat and the gracilis muscle to reconstruct the new breast. Unlike loss of other muscles (like the rectus abdominus), loss of the gracilis muscle does not result in any noticeable functional impairment. The tissue is dissected from the inner thigh and transplanted to the chest where it is reattached micro surgically.
Preparation for Surgery
The surgery usually takes 4- 6 hour for one side and 8-10 hours for both sides. It will take about 1-2 hour longer if you will also have mastectomy at the same time. You will stay in the surgical ICU for flap monitoring for 48 hours. Most patients will be discharged home by postoperative day 4 or 5.
Restriction and Recovery
It is important that you restrict your physical activities for 4-6 weeks. All patients will get back to their baseline activities by the end of 6 weeks.
For one breast reconstruction, many patients requests the opposite breast lift or reduction which usually performs after the reconstructed breast settling down (usually 3 months). Your health insurance is obligated to cover you care.
Sometimes, the fat grafting technique is required to further increase the size of reconstructed breast. The fat is harvested using liposuction technique. This “free” liposuction will further shaping your body. The nipple reconstruction usually performed after you satisfy with the size and shape of both breasts.