Breast reconstruction (DIEP and TUG free flaps)

Breast reconstruction is a surgical procedure aimed at restoring the shape and appearance of the breast following mastectomy or lumpectomy.

The DIEP (Deep Inferior Epigastric Perforator) flap and TUG (Transverse Upper Gracilis) flap are advanced techniques that use the patient’s own tissue to recreate a natural-looking breast. These procedures are designed to offer a permanent solution without the need for implants, providing more natural results.

Procedure overview

Type of anaesthetic

  • General

Length of operation

  • 6-8 hours

Length of hospital stay

  • 3-5 days

Recovery period

  • 6 weeks before driving

  • 8-12 weeks before strenuous activity

What you need to know

Suitability

Ms. Teo will conduct a thorough medical history review and physical examination to determine the most suitable reconstruction option for you.

Generally, the abdominal (DIEP) flap is ideal for women with sufficient abdominal tissue.

The thigh (TUG) flap is a suitable alternative for those with insufficient abdominal tissue or those who have had previous abdominal surgeries. This option is particularly effective for women with small to moderate-sized breasts and more generous thigh tissue.

Combination with other treatments

Nipple reconstruction: Some ladies elect to undergo nipple reconstruction after their free flap surgery. This can be performed under local anaesthetic and involves making some cuts in the skin, creating two small ‘wings’ that are then stitched together to create a bud. This can followed up by nipple tattooing.

Lipofilling: the reconstructed breast may be slightly smaller or bigger then anticipated. The breast can be made smaller with liposuction (link to liposuction page) or bigger with lipofilling, where fat is harvested from another area and transferred to the breast.

Symmetrising (balancing) surgery: If you feel the other breast needs a lift or reduction for a good match, this can be discussed at your consultation.

Transverse Upper Gracilis (TUG) Flap

The TUG flap breast reconstruction is a surgical procedure used to recreate the breast following mastectomy. This technique utilizes tissue from the inner thigh, specifically the gracilis muscle, along with the overlying skin and fat, to form a new breast. The TUG flap is an excellent option for patients who may not have enough abdominal tissue for other flap procedures like the DIEP flap.

The TUG flap method involves harvesting tissue from the upper inner thigh, which provides the added benefit of a thigh lift in the donor area. The harvested tissue, along with its blood vessels, is then transplanted to the chest and meticulously reconnected to the blood vessels there using microsurgical techniques. This ensures adequate blood flow and survival of the transplanted tissue.

Deep Inferior Epigastric Perforator (DIEP) Flap

DIEP flap breast reconstruction is an advanced surgical procedure used to rebuild the breast after mastectomy. This method utilises the patient's own abdominal skin and fat to create a natural-looking breast, without sacrificing the underlying abdominal muscles. The DIEP flap technique offers several benefits, including a more natural feel and appearance of the reconstructed breast, reduced risk of abdominal weakness or hernia, and simultaneous body contouring.

During the procedure, a section of skin and fat from the lower abdomen is carefully detached and transplanted to the chest to form the new breast. The blood vessels (perforators) are meticulously reconnected to ensure proper blood flow to the new tissue. This microsurgical technique requires a high level of expertise and precision, making it one of the most specialized forms of breast reconstruction available.

Consultation

During your initial consultation Ms. Teo will take a comprehensive medical history, including details of your cancer diagnosis, treatments received, and any future treatment plans. She will also enquire about your lifestyle and family support. A thorough examination of your chest wall, breast size, and tissue will be conducted to determine the reconstructive options available to you.

Ms. Teo dedicates significant time at this stage to get to know you personally and understand your expectations for reconstructive surgery. After completing a comprehensive assessment, she will discuss all reconstructive options with you, even if you are already leaning towards a particular type of reconstruction.

Ms. Teo will thoroughly explain her recommended procedure, including details on the surgery timeframes, potential risks, and necessary aftercare. She encourages her patients to attend the BRA (Breast Reconstruction Awareness) group, a support group established by the Oxford Plastic Surgery Department. This group is designed for women who have either undergone, are currently awaiting, or are considering breast reconstruction. The sessions are free and held monthly, providing a valuable resource for support and information.

Potential complications

As with any surgical procedure, liposuction carries certain risks, including infection, bleeding, and adverse reactions to anesthesia.

There is also a risk of abdominal or thigh weakness and scarring, or fat necrosis (where some of the transferred fat tissue does not survive)

Ms Teo will discuss all possible risks and complications during your consultation to ensure you make an informed decision.

 FAQs

  • The DIEP (Deep Inferior Epigastric Perforator) flap uses skin, fat, and blood vessels from the lower abdomen to reconstruct the breast, while preserving the abdominal muscles. The TUG (Transverse Upper Gracilis) flap uses tissue from the inner thigh, including part of the gracilis muscle, to create the new breast. Both methods involve microsurgery to connect blood vessels but differ in the donor site location.

  • Ladies who need a mastectomy, either for cancer or risk reducing reasons (like being a BRACA gene carrier), or have had a mastectomy, may be suitable candidates if they have adequate amount of skin and fat on the abdomen. Patients who have had previous abdominal surgeries or those with certain medical conditions may need to be evaluated on a case-by-case basis.

  • The benefits of DIEP flap reconstruction include a natural look and feel of the breast, preservation of abdominal muscles, a lower risk of hernias or abdominal weakness, and an added benefit of a tummy tuck-like effect due to the removal of lower abdominal tissue.

  • Previous abdominal surgeries may affect your suitability for DIEP flap reconstruction. Ms Teo will evaluate your medical history and may recommend alternative reconstruction options if necessary.

  • Because the DIEP flap technique preserves the abdominal muscles, most patients do not experience significant long-term weakness. However, some temporary discomfort and weakness are common during the initial recovery period.

  • Yes, there will be scars both on the breast and the lower abdomen. The abdominal scar is typically positioned low, similar to a tummy tuck scar, and can often be concealed by underwear or swimwear. Scarring on the breast depends on the specifics of the mastectomy and reconstruction.

  • The TUG flap is used for breast reconstruction in ladies with small to moderate sized breasts who would like reconstruction using their own tissue and have enough tissue on their inner thighs.

  • Benefits include a natural look and feel of the reconstructed breast, the use of the patient’s own tissue, and an additional thigh lift effect. This technique is particularly suitable for patients who do not have enough abdominal tissue for other flap procedures

  • The TUG flap involves removing the gracilis muscle, which plays a minor role in leg function. Most patients do not experience significant long-term weakness, although some temporary discomfort and weakness in the thigh are common during the initial recovery period

  • Yes, there will be scars on both the breast and the inner thigh. The thigh scar is typically positioned below the groin crease. Breast scarring will depend on the specifics of the mastectomy and reconstruction.

  • Yes, TUG flap reconstruction can be performed immediately following mastectomy (immediate reconstruction) and lymph node surgery (if indicated).

  • Breast reconstruction using DIEP or TUG flaps typically offers very natural-looking and feeling results because the tissue used is your own. The reconstructed breast will age naturally with your body and generally provides a more realistic texture compared to implants.

  • In many cases, breast reconstruction is covered by insurance, as it is considered part of the treatment for breast cancer. This includes reconstruction of the affected breast as well as procedures to achieve symmetry with the other breast. It's important to check with your insurance provider to understand your coverage and any associated costs.

  • You must not drive for 4-6 weeks after free flap surgery surgery. When all your wounds are completely healed, simulate an emergency brake in an empty carpark. If you feel entirely safe and in control at this stage, then you are safe to resume driving.

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