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Updated: December 2011

Skin-sparing Mastectomies, TUG flaps


skin sparing mastectomies TUG flaps preop
skin sparing mastectomies TUG flaps post-op
Before
After

This patient is seen before and after bilateral skin-sparing mastectomies and transverse upper gracilis (TUG) flap breast reconstruction. As she desired a natural reconstruction, she preferred utilizing her own tissue over implants. The TUG flap was chosen because of her athletic body type with minimal abdominal fatty tissue for DIEP flap reconstruction. Therefore, the TUG flap was a more favorable option to achieve a natural reconstruction of both breasts with sufficient volume.

Suzanne's Breast Reconstruction Story:

 

My cancer was found at age 51 years old on a routine mammogram. I relied on referrals to breast surgeons and plastic reconstructive surgeons through word of mouth. Given my type of cancer, the options presented by my breast surgeon were a lumpectomy followed by radiation or a mastectomy with immediate reconstruction. I had decided to be pro-active and have a bi-lateral mastectomy. During my meeting with a plastic surgeon who specializes in microsurgical techniques, it was suggested that my best options were a TUG or direct implants based on my body type and athletic life style. I also did not have sufficient fat on my belly for a DIEP and did not like the idea of using an implant. After viewing reconstruction photos of other women who shared these similarities, it was clear that the TUG approach resulted in the most natural outcome. My preference was to use my own body and this offered me that option. I also knew instantly that I could get the benefit of revising the one part of my body that I considered to be a “figure flaw” (thighs)…a bonus of this whole journey.

I did not experience any pain from the incisions, drains or my legs…solely back pain from previous back issues I have had. In retrospect, had I communicated this in advance of the surgery, modifications might have been made for my positioning on the operating table. Pain medication was only used for this reason. Stairs were off limits for one week following surgery and were difficult to negotiate for several weeks until the drains were removed and then gingerly and creatively approached (sometimes with use of a walker). My frustrations were on my initial limited range of motion, general mobility and bathroom hygiene. In retrospect, I wished that I had asked sooner about exercising my arms.

But, there I was taking short walks around the block and doing “laps” in my house within one week of my surgery…drains and all! Within 3 weeks, I was back to work part-time and full-time by 6 weeks. At the four month mark, I was back to working out at the gym at 5:30am (5x/week), travelling an hour by train to my job and working a 10 hour day.

I strongly recommend that you refer to this web-site for tips on Pre and Post Op Care. This will help you in preparing your home and making things more comfortable for you. A few extra suggestion that I would like to share:

  • Line up friends to be emotionally available to your children.
  • Prepare a cd of comforting music to be played in the OR. Nostalgic rock comforts me.
  • Just prior to surgery, pull out your coping tools: I bring God into every situation, some people may meditate, use breathing techniques, but I rely on prayer. God guides, guards, and governs every situation, the Dr's, nurses, my family, myself.....The 3-G's, I call it.

I strongly believe that prayer and my relationship with G-d were the major factors in moving through this process from the time of diagnosis to the present. At five months post op, I have based my physical recovery on the height of my SHOES! I went from flats (sturdy shoes, initially) to 4” wedges! Time was needed to strengthen my legs/thighs so “don’t freak” if you feel unsteady for the first three or so months.

Once my nipples were constructed, my focus shifted away from the journey I had traveled. I was warned that immediately following this stage the nipples appear much larger (like headlights or the warning on your side view mirror) than they will eventually be and to feel assured that they will significant reduce in size. I am surprised to find that my level of comfort with my body and my mind set is CHANGING…. From that point on, I no longer said, “Oh, cancer, Oh, Sh-t!” As a very private person, I did not share my diagnosis and treatment with many individuals, especially those I felt might be untrustworthy or gossip. I’m not hiding at this point and find when asked by those seeing me return to activities (from which I had taken a hiatus for treatment) if I’ve had some “work done on my face”, I may candidly tell certain people that I had a double mastectomy and used my own tissue to reconstruct these younger, perkier looking breasts. I don't elaborate and won't ever give the nitty, gritty details. I will share the comparison of a root canal....people don't discuss the size or stage of a root canal and that I prefer to look at "this" situation the same way. Not to minimize what others may go thru, but for my own sanity, I had to simplify the situation.....

While at this point in time, there remain some residual emotional issues, I now feel that my breasts are a part of me…the disconnect has disappeared. The physical contact and affection with my spouse is even greater than before and while intimacy has been impacted by flexibility, I have great hope for the road ahead.

 

Photos and Doctor Commentary
 

skin sparing mastectomies TUG flaps preop skin sparing mastectomies TUG flaps post-op

Preoperative

Suzanne presented for consultation for bilateral breast reconstruction that would be done concurrently with the scheduled bilateral mastectomy for breast cancer. On examination she had an athletic body type with minimal abdominal fatty tissue. As she desired to use her own tissue for the reconstruction, the plan for TUG flap reconstruction was chosen in order to provide a bilateral reconstruction with sufficient volume and natural feel and appearance. Even in very thin women the inner thigh typically has sufficient expandable tissue that can be transferred for breast reconstruction using the TUG flap.

 

 skin sparing mastectomies TUG flaps after 1st stage skin sparing mastectomies TUG flaps post-op

Post-operative bilateral skin-sparing mastectomies and TUG flap breast reconstruction

Here is Suzanne 3 months after her bilateral mastectomies and TUG flap breast reconstruction. She has recovered well from the surgery. The reconstructed breasts show good volume with minor contour irregularities that will be addressed during the second stage. The flap skin replacing the nipple and areola in the center of the reconstructed breasts will be used for the nipple reconstruction. The thigh scar is healing well with slightly thinner contour of the upper thighs. Since the TUG flap was designed with a fleur-de-lis shape to optimize the volume, the inner thighs have a horizontal and vertical scar. Both are well hidden from the front. Suzanne is now ready for the second stage of the reconstruction.

 

skin sparing mastectomies TUG flaps after 2nd stage  

After bilateral nipple reconstruction and breast revision with fat injection.

The shape of the nipples was reconstructed using the skin island from the TUG flaps. The reconstructed breasts show improved contour and symmetry. After allowing some time for healing, the reconstructed nipples and areolar are tattooed.

 

 skin sparing mastectomies TUG flaps post-op

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skin sparing mastectomies TUG flaps post-op  skin sparing mastectomies TUG flaps post-opskin sparing mastectomies TUG flaps post-op  

Completed bilateral DIEP flap breast reconstruction

This is Suzanne’s completed breast reconstruction. She is seen 9 months after her skin-sparing mastectomies and TUG flap breast reconstruction. As the TUG flap was designed with a fleur-de-lis shape to optimize the volume, the inner thighs have a horizontal and vertical scar. Both are well hidden from the front.