SGAP Flap and TUG Flap

For women who are not good candidates for a DIEP Flap or other types of reconstruction, they may be suited for SGAP Flap and TUG Flap. These two flap reconstruction techniques make use of skin and tissue from the backside (SGAP) and the upper inner thigh (TUG). Both SGAP Flap and TUG Flap are considered effective breast reconstruction techniques following a mastectomy.

SGAP Breast Reconstruction

SGAP Flap
superior gluteal artery perforator flap

When women do not have an abdominal donor site, either because they are too thin or have already had a tummy tuck or liposuction, other sites are examined to see if there is ample tissue to transplant and make a breast. One other common place is the buttock. Tissue can be harvested from either the upper or the lower buttock-based on its blood supply and transplanted to the chest and shaped into a breast. All of the gluteal muscle remains in place. Our practice prefers the upper buttock over the lower buttock because the scar is less painful, there is often more tissue able to be harvested from the upper buttock/love-handle region, and the result is a lifted, more youthful looking buttocks.

In the SGAP flap, skin and fat are harvested from the buttock with the patient on their side or lying face down. The buttock is then closed, giving a bit of a buttock lift, and the patient then turned onto their back. The buttock tissue is then attached to blood vessels under the ribs with microsurgical techniques and shaped to look like a breast. This procedure is more difficult that abdominal tissues, so our practice prefers to do only one breast per surgery. Most women need one additional revision of their buttock scar at a later time to make it appear as cosmetic as possible.

TUG Breast Reconstruction

TUG Flap
transverse upper gracilis flap

Another favorable donor site for breast reconstruction is the upper inner thigh. The gracilis muscle is a small, thin muscle in the inner thigh that starts at the pubic bone and attaches to the medial knee. It helps with adduction, or bringing the thigh inward, but is a muscle that is not necessarily needed and it contains the blood supply to the skin in the upper thigh. Skin, fat and the gracilis muscle are harvested and them transplanted to the chest, just like the DIEP and SGAP flap, and connected to the blood vessels there. The tissue is then shaped to make a breast.

Because tissue is harvested in the upper inner thigh, closure of the wound created a lifted appearance to the thigh and attempts to conceal the scar along the panty line (much like a thigh lift). This flap is a reasonable option for women who do not have tissue on their abdomen or who have had failed attempts at reconstruction and need another option. The tissue is limited so it creates smaller breast reconstructions. Women who desire larger breasts will still require an implant. The scar in the inner thigh often has some wound healing issues and may cause the leg to have swelling for a period of time.

Questions to Ask Your Surgeon

  • Which flap is best for me and why?
  • How many of these reconstructions have you done?
  • What will my donor site look like?
  • What will my recovery be like and what are my restrictions?

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